Critical care use during the course of serious illness.

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dc.contributor.author Iwashyna, Theodore J.
dc.date.accessioned 2008-12-18T21:55:42Z
dc.date.available 2008-12-18T21:55:42Z
dc.date.issued 2004-11
dc.identifier.citation Am J Respir Crit Care Med. 2004 Nov 1;170(9):981-6. Epub 2004 Jul 21 <http://hdl.handle.net/2027.42/61412> en
dc.identifier.uri http://hdl.handle.net/2027.42/61412
dc.identifier.uri http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=15271691&dopt=citation
dc.description.abstract Despite its expense and importance, it is unknown how common critical care use is. We describe longitudinal patterns of critical care use among a nationally representative cohort of elderly patients monitored from the onset of common serious illnesses. A retrospective population-based cohort study of elderly patients in fee-for-service Medicare is used, with 1,108,060 Medicare beneficiaries at least 68 years of age and newly diagnosed with serious illnesses: 1 of 9 malignancies, stroke, congestive heart failure, hip fracture, or myocardial infarction. Medicare inpatient hospital claims from diagnosis until death (65.1%) or fixed-right censoring (more than 4 years) were reviewed. Distinct hospitalizations involving critical care use (intensive care unit or critical care unit) were counted and associated reimbursements were assessed; repeated use was defined as five or more such hospitalizations. Of the cohort, 54.9% used critical care at some time after diagnosis. Older patients were much less likely to ever use critical care (odds ratio, 0.31; comparing patients more than 90 years old with those 68-70 years old), even after adjustment. A total of 31,348 patients (2.8%) were repeated users of critical care; they accounted for 3.6 billion dollars in hospital charges and 1.4 billion dollars in Medicare reimbursement. We conclude that critical care use is common in serious chronic illness and is not associated solely with preterminal hospitalizations. Use is uneven, and a minority of patients who repeatedly use critical care account for disproportionate costs. en
dc.format.extent 101500 bytes
dc.format.extent 170243 bytes
dc.format.mimetype application/pdf
dc.format.mimetype application/pdf
dc.language.iso en_US en
dc.publisher American Journal of Respiratory and Critical Care Medicine en
dc.subject Medicare en
dc.subject ICU en
dc.subject Critical Care en
dc.subject Longterm Outcomes en
dc.title Critical care use during the course of serious illness. en
dc.type Article en
dc.subject.hlbsecondlevel Internal Medicine and Specialities
dc.subject.hlbtoplevel Health Sciences
dc.description.peerreviewed Peer Reviewed en
dc.contributor.affiliationum Pulmonary and Critical Care Medicine, Division of en
dc.contributor.affiliationum Internal Medicine, Department of en
dc.contributor.affiliationumcampus Ann Arbor en
dc.identifier.pmid 15271691
dc.description.bitstreamurl http://deepblue.lib.umich.edu/bitstream/2027.42/61412/2/04.AJRCCM.supp.pdf
dc.description.bitstreamurl http://deepblue.lib.umich.edu/bitstream/2027.42/61412/1/04.AJRCCM.pdf
dc.owningcollname Pulmonary & Critical Care Medicine, Division of
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