http://hdl.handle.net/2027.42/61401 2013-05-24T21:54:13Z http://hdl.handle.net/2027.42/97546 Trends in the incidence of noncardiogenic acute respiratory failure: the role of race Cooke, Colin; Erickson, Sara; Eisner, Mark; Martin, Greg Objective—We sought to examine trends in the race-specific incidence of acute respiratory failure in the United States. Design—Retrospective cohort study. Setting—We used the National Hospital Discharge Survey (NHDS) database (1992-2007), an annual survey of approximately 500 hospitals weighted to provide national hospitalization estimates. Patients—All incident cases of noncardiogenic acute respiratory failure hospitalized in the United States. Interventions—None Measurements and Main Results—We identified noncardiogenic acute respiratory failure by the presence of ICD–9 codes for respiratory failure or pulmonary edema (518.4, 518.5, 518.81, 518.82) and mechanical ventilation (96.7x), excluding congestive heart failure. Incidence rates were calculated using yearly census estimates standardized to the age and sex distribution of the 2000 census population. Annual cases of noncardiogenic acute respiratory failure increased from 86,755 in 1992 to 323,474 in 2007. Noncardiogenic acute respiratory failure among black Americans increased from 56.4 (95% CI 39.7 – 73.1) to 143.8 (95% CI 123.8 – 163.8) cases per 100,000 in 1992 and 2007, respectively. Among white Americans, the incidence of noncardiogenic acute respiratory failure increased from 31.2 (95% CI 26.2-36.5) to 94.0 (95% CI 86.7 – 101.2) cases per 100,000 in 1992 and 2007, respectively. The average annual incidence of noncardiogenic acute respiratory failure over the entire study period was 95.1 (95% CI 93.9 – 96.4) cases per 100,000 for black Americans compared to 66.5 (95% CI 65.8 – 67.2) cases per 100,000 for white Americans (rate ratio = 1.43, 95% CI 1.42-1.44). Overall in–hospital mortality was greater for other-race Americans, but only among patients with ≥ 2 organ failures (57% [95% CI 56-59%] for other-race, 51% [95% CI, 50-52%] for white, 50% [95% CI, 49-51%] for black). Conclusions—The incidence of noncardiogenic acute respiratory failure in the United States increased between 1992 and 2007. Black and other-race Americans are at greater risk of developing noncardiogenic acute respiratory failure compared to white Americans. 2012-05-01T00:00:00Z http://hdl.handle.net/2027.42/93632 Trajectories of Recovery and Dysfunction after Acute Illness, with Implications for Clinical Trial Design Iwashyna, Theodore J We do not understand the trajectories of recovery after critical illness, and this limits our ability to appropriately evaluate novel interventions in randomized controlled trials 2012-08-15T00:00:00Z http://hdl.handle.net/2027.42/93631 The incomplete infrastructure for interhospital patient transfer Iwashyna, Theodore J OBJECTIVE: Interhospital transfer of critically ill patients is a common part of their care. This article sought to review the data on the current patterns of use of interhospital transfer and identify systematic barriers to optimal integration of transfer as a mechanism for improving patient outcomes and value of care. DATA SOURCE: Narrative review of medical and organizational literature. SUMMARY: Interhospital transfer of patients is common, but not optimized to improve patient outcomes. Although there is a wide variability in quality among hospitals of nominally the same capability, patients are not consistently transferred to the highest quality nearby hospital. Instead, transfer destinations are selected by organizational routines or non-patient-centered organizational priorities. Accomplishing a transfer is often quite difficult for sending hospitals. But once a transfer destination is successfully found, the mechanics of interhospital transfer now appear quite safe. CONCLUSION: Important technological advances now make it possible to identify nearby hospitals best able to help critically ill patients, and to successfully transfer patients to those hospitals. However, organizational structures have not yet developed to insure that patients are optimally routed, resulting in potentially significant excess mortality. 2012-08-01T00:00:00Z http://hdl.handle.net/2027.42/93630 The Burdens of Survivorship: An Approach to Thinking about Long-Term Outcomes after Critical Illness. Iwashyna, Theodore J.; Netzer, Giora Internationally accepted approaches to the study of functioning and disability can inform critical care practitioners and scholars in their study of functional limitations, disability, and quality of life after critical illness and intensive care. Therefore this article provides an introduction to the World Health Organization's International Classification of Functioning, Disability and Health (ICF). The Institute of Medicine has also recommended this approach for the study of disability. This conceptual framework divides potential problems as follows: problems in body structure and tissue, limitations in activity (i.e., functional limitations as assessed in standardized environments), and restrictions in participation (i.e., the inability to fulfill a social role). The ICF draws attention to effect modifiers that can prevent problems at one level from progressing (or conversely can hasten their progression) to profound decrements in a patient's quality of life. It is particularly relevant for studies of long-term outcomes after critical illness and post-intensive care syndrome (PICS). This article provides a discussion of the ICF specific to the intensive care unit and the disablement process, with particular attention to new opportunities for intervention and their implications for cost and quality of life. 2012-08-01T00:00:00Z