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BACKGROUND/RATIONALE:
Hospital discharge is an important transition point for patients who have been in ICUs. The physical, functional, and psychosocial changes associated with recovery from critical illness present challenges for patients, families, and healthcare providers involved in the patients' care. While the complex discharging needs of ICU survivors have been increasingly recognized1-3, little rigorous research or evaluation has been conducted in this area.
OBJECTIVE(S):
The objectives of this study are to 1) assess the feasibility of constructing outcome measures of care transitions for patients discharged from intensive/critical units (ICUs) using existing VA national databases; and 2) examine the associations of patient and organizational factors with post-ICU discharge outcomes, including mortality, post discharge clinic visit, hospital readmission, and medication prescribing patterns.
METHODS:
The proposed study is a short-term project (6 months) designed to provide initial evidence for standardizing tools for use in ICUs, and for measuring recovery after an ICU stay. For Objective 1, we will perform a comprehensive review of literature to identify outcome measures that have been used to evaluate care transitions for ICU survivors. Available data elements in VA data systems will be determined from definitions provided in technical and user guides of VA data sources. Feasibility will be evaluated by comparing operational definitions of outcome measures from literature with descriptions of data elements from VA data sources. For Objective 2, we will use an observational cross-sectional design to assess contributing factors of post-ICU health outcomes. The unit of analysis will be at the patient level and the study period from 4/06-3/07. We will include first admission of patients who had an ICU stay and were discharged during the study period from 20 randomly selected VAMCs, stratifying by ICU levels, region, and facility complexity grouping. We select this smaller number of facilities to allow more in-depth investigator. Outcome and independent variables (patient demographics, patient health status, and facility characteristics) will be constructed from utilization and pharmacy data for the one year following the index hospital discharge. We will analyze data using multilevel mixed-effects linear regression for continuous outcomes and generalized linear latent and mixed models for binary outcomes. We will use Kaplan-Meier survival curves to evaluate the associations of survival after discharge, time to recurrence of the index admission DRG, and time to first clinic visit with patient and facility characteristics. We will use hierarchical Cox regression to derive an adjusted ratio at 95% confidence interval. Multivariate regressions will be corrected for clustering at the unit and facility levels.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
This analysis will assist in determining information resources that are available or needed to provide better care to patients with critical illness. Findings from this pilot study will provide initial evidence to standardize tools for use in ICUs, and for measuring recovery after an ICU stay.
PUBLICATIONS:
None at this time.
DRA:
Acute and Traumatic Injury
DRE:
none
Keywords:
none
MeSH Terms:
none
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