TY - JOUR
T1 - Outcomes and patterns of healthcare utilization after hospitalization for pediatric critical illness due to respiratory failure
AU - Yagiela, Lauren M.
AU - Barbaro, Ryan P.
AU - Quasney, Michael W.
AU - Pfarr, Marie A.
AU - Ursu, Dan C.
AU - Prosser, Lisa A.
AU - Odetola, Fola O.
N1 - Funding Information:
Supported, in part, by the Department of Pediatrics and Communicable Diseases and Division of Pediatric Critical Care Medicine at the University of Michigan.
Funding Information:
1Critical Care Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI. 2Division of Pediatric Critical Care Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI. 3Child Health Evaluation and Research Center, Department of Pediatrics lthough mortality from childhood critical illness is Dr. Ursu received support for article research from the University of Michigan Department of Pediatrics (research grant). Dr. Odetola received funding from the American Board of Pediatrics (Member, sub-board of critical care medicine). The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: lyagiela@dmc.org Copyright © 2018 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
Publisher Copyright:
© 2018 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
PY - 2019/2/1
Y1 - 2019/2/1
N2 - Objectives: To quantify home care needs, healthcare utilization, and 2-year mortality after pediatric critical illness due to respiratory failure, and evaluate the impact of new morbidity and abnormal function at hospital discharge on resource use and outcomes. Design: Retrospective cohort study. Setting: Quaternary care PICU. Patients: Patients less than or equal to 18 years with respiratory failure from January 1, 2013, to December 31, 2014. Measurements and Main Results: Patient demographics, hospitalization characteristics, and healthcare utilization were quantified and compared according to morbidity development and discharge functional status. Multivariable regression methods evaluated 2-year readmission rates and mortality by morbidity development and discharge functional status. Of 163 patients, the median age was 2.1 years (interquartile range, 0.6-10.9 yr), 61 (37.4%) had a comorbidity, and 73 (44.8%) had abnormal function at admission. Median ventilation duration was 6.0 days (interquartile range, 3.0-11.7 d), and median PICU and hospital length of stay were 8 (interquartile range, 4-15) and 14 days (interquartile range, 8-23 d), respectively. At hospital discharge, eight of 163 (4.9%) had died, and 14 of 163 (8.6%) had a new morbidity. Of the surviving 155 patients at hospital discharge, 87 (56.1%) had abnormal function, 120 (77.4%) had new medications, 24 (15.5%) had new medical devices, and 43 (27.7%) had new home care equipment. Cumulative 2-year mortality was 14 of 163 (8.6%) with six of 163 (3.7%) occurring after discharge. Within 2 years, 81 of 155 of patients (52.2%) were readmitted, often (58/81, 71.6%) to the PICU. Abnormal function at discharge was associated with elevated odds of readmission to the hospital (odds ratio, 1.49; 1.28-1.74; p < 0.0001) and PICU (odds ratio, 1.47; 1.27-1.71; p < 0.0001) within 2 years. Conclusions: After critical illness, children have significant new healthcare burdens heretofore unrecognized. Abnormal functional status at hospital discharge was associated with increased healthcare utilization up to 2 years thereafter.
AB - Objectives: To quantify home care needs, healthcare utilization, and 2-year mortality after pediatric critical illness due to respiratory failure, and evaluate the impact of new morbidity and abnormal function at hospital discharge on resource use and outcomes. Design: Retrospective cohort study. Setting: Quaternary care PICU. Patients: Patients less than or equal to 18 years with respiratory failure from January 1, 2013, to December 31, 2014. Measurements and Main Results: Patient demographics, hospitalization characteristics, and healthcare utilization were quantified and compared according to morbidity development and discharge functional status. Multivariable regression methods evaluated 2-year readmission rates and mortality by morbidity development and discharge functional status. Of 163 patients, the median age was 2.1 years (interquartile range, 0.6-10.9 yr), 61 (37.4%) had a comorbidity, and 73 (44.8%) had abnormal function at admission. Median ventilation duration was 6.0 days (interquartile range, 3.0-11.7 d), and median PICU and hospital length of stay were 8 (interquartile range, 4-15) and 14 days (interquartile range, 8-23 d), respectively. At hospital discharge, eight of 163 (4.9%) had died, and 14 of 163 (8.6%) had a new morbidity. Of the surviving 155 patients at hospital discharge, 87 (56.1%) had abnormal function, 120 (77.4%) had new medications, 24 (15.5%) had new medical devices, and 43 (27.7%) had new home care equipment. Cumulative 2-year mortality was 14 of 163 (8.6%) with six of 163 (3.7%) occurring after discharge. Within 2 years, 81 of 155 of patients (52.2%) were readmitted, often (58/81, 71.6%) to the PICU. Abnormal function at discharge was associated with elevated odds of readmission to the hospital (odds ratio, 1.49; 1.28-1.74; p < 0.0001) and PICU (odds ratio, 1.47; 1.27-1.71; p < 0.0001) within 2 years. Conclusions: After critical illness, children have significant new healthcare burdens heretofore unrecognized. Abnormal functional status at hospital discharge was associated with increased healthcare utilization up to 2 years thereafter.
KW - critical care outcomes
KW - critical illness/mortality
KW - outcome assessment (healthcare)/methods
KW - pediatric
KW - pediatric intensive care units
KW - survivor
UR - http://www.scopus.com/inward/record.url?scp=85061066988&partnerID=8YFLogxK
U2 - 10.1097/PCC.0000000000001797
DO - 10.1097/PCC.0000000000001797
M3 - Article
C2 - 30418338
AN - SCOPUS:85061066988
SN - 1529-7535
VL - 20
SP - 120
EP - 127
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 2
ER -