Healthcare utilization and costs in ARDS survivors: a 1-year longitudinal national US multicenter study
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To evaluate (1) post-discharge healthcare utilization and estimated costs in ARDS survivors, and (2) the association between patient and intensive care-related variables, and 6-month patient status, with subsequent hospitalization and costs.
Longitudinal cohort study enrolling from four ARDSNet trials in 44 US hospitals. Healthcare utilization was collected via structured interviews at 6 and 12 months post-ARDS, and hospital costs estimated via the Medical Expenditure Panel Survey. Adjusted odds ratios for hospitalization and adjusted relative medians for hospital costs were calculated using marginal two-part regression models.
Of 859 consenting survivors, 839 (98%) reported healthcare utilization, with 52% female and a mean age of 49 years old. Over 12 months, 339 (40%) patients reported at least one post-discharge hospitalization, with median estimated hospital costs of US$18,756 (interquartile range $7852–46,174; 90th percentile $101,500). Of 16 patient baseline and ICU variables evaluated, only cardiovascular comorbidity and length of stay were associated with hospitalization, and sepsis was associated with hospital costs. At 6-month assessment, better patient-reported physical activity and quality of life status were associated with fewer hospitalizations and lower hospital costs during subsequent follow-up, and worse psychiatric symptoms were associated with increased hospitalizations.
This multicenter longitudinal study found that 40% of ARDS survivors reported at least one post-discharge hospitalization during 12-month follow-up. Few patient- or ICU-related variables were associated with hospitalization; however, physical, psychiatric, and quality of life measures at 6-month follow-up were associated with subsequent hospitalization. Interventions to reduce post-ARDS morbidity may be important to improve patient outcomes and reduce healthcare utilization.
KeywordsPatient readmission Healthcare Cost Quality of life Critical illness
We thank all of the patients and their proxies who participated in this study. We thank Caroline Chessare, Mardee Merrill, Mariela Pinedo, Kyle Schneck, Stacey Schoonmaker, Kristin Sepulveda, Marcella Shrout, Cassie Wicken, Melissa McCullough, Jonathan Gellar, Elizabeth Vayda, Gita Byraiah, Laura Methvin, Vanessa Stan, Shirani Rajan, Cassie Wicken, Meg Shanahan, Elizabeth Baer, and Anita Chandra who assisted with data collection; and Lin Chen, William Flickinger, and Christopher Mayhew who assisted with data management.
Investigators and research staff from National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network sites that participated in this follow-up study: University of Washington, Harborview (*L. Hudson, S. Gundel, C. Hough, M. Neff, K. Sims, A. Ungar, T. Watkins); Providence-Everett Medical Center (S. Lubatti, T.Ziedalski); Baystate Medical Center (*J. Steingrub, M. Tidswell, E. Braden, L. DeSouza, C. Kardos, L. Kozikowski, S. Ouellette); Baylor College of Medicine (K. Guntupalli, V. Bandi, C. Pope, C. Ross); Johns Hopkins University (*R. Brower, H. Fessler, D. Hager, P. Mendez-Tellez, D. Needham, K. Oakjones); Johns Hopkins Bayview Medical Center (J. Sevransky, A. Workneh); University of Maryland (C. Shanholtz, D. Herr, H. Howes, G. Netzer, P. Rock, A. Sampaio, J. Titus); Union Memorial Hospital (P. Sloane, T. Beck, D. Highfield, S. King); Washington Hospital Center (B. Lee, N. Bolouri); Franklin Memorial Hospital Center (S. Selinger, S King); St Josephs Hospital of Baltimore (L Barr); Cleveland Clinic Foundation (*H.P. Wiedemann, R.W. Ashton, D.A. Culver, T. Frederick, J.A. Guzman, J.J. Komara Jr, A.J. Reddy); University Hospitals of Cleveland (R. Hejal, M. Andrews, D. Haney); MetroHealth Medical Center (A.F. Connors, S. Lasalvia, J.D. Thornton, E.L. Warren); University of Colorado Hospital, Aurora (*M. Moss, E.L. Burnham, L. Gray, J. Maloney, M. Mealer); Denver Health Medical Center (I. Douglas, K. Overdier, K. Thompson, R. Wolken); Rose Medical Center (S. Frankel, J. McKeehan); Swedish Medical Center (M.L. Warner); Saint Anthony’s Hospital (T. Bost, C. Higgins, K. Hodgin); Duke University (*N. MacIntyre, L. Brown, C. Cox, M. Gentile, J. Govert, N. Knudsen); University of North Carolina (S. Carson, L. Chang, S. Choudhury, W. Hall, J. Lanier); Vanderbilt University (*A.P. Wheeler, G.R. Bernard, M. Hays, S. Mogan, T.W. Rice); Wake Forest University (*R.D. Hite, A. Harvey, P.E. Morris, Mary Ragusky); Moses Cone Memorial Hospital (P. Wright, S. Groce, J. McLean, A. Overton); University of Virginia (J. Truwit, K. Enfield, M. Marshall); Intermountain Medical Center (*A. Morris, *C. Grissom, A. Austin, S. Barney, S. Brown, J. Ferguson, H. Gallo, T. Graydon, E. Hirshberg, A. Jephson, N. Kumar, M. Lanspa, R. Miller, D. Murphy, J. Orme, A. Stowe, L. Struck, F. Thomas, D. Ward,); LDS Hospital (P. Bailey, W. Beninati, L. Bezdjian, T. Clemmer, S. Rimkus, R. Tanaka, L. Weaver); McKay Dee Hospital (C. Lawton, D. Hanselman); Utah Valley Regional Medical Center (K. Sundar, W. Alward, C. Bishop, D. Eckley, D. Harris, T. Hill, B. Jensen, K. Ludwig, D. Nielsen, M. Pearce); University of California, San Francisco (*M.A. Matthay, C. Calfee, B. Daniel, M. Eisner, O. Garcia, K. Kordesch, K. Liu, N. Shum, H. Zhou); University of California, San Francisco, Fresno (M.W. Peterson, J. Blaauw, K. Van Gundy); San Francisco General Hospital (R. Kallet, E. Johnson); University of California, Davis (T. Albertson, B. Morrissey, E. Vlastelin); Stanford (J. Levitt, E. Kovoor, R. Vojnik); Louisiana State University Health Sciences Center-New Orleans (*B. deBoisblanc, A. Antoine, D. Charbonnet, J. Hunt, P. Lauto, A. Marr, G. Meyaski, C. Romaine); Earl K. Long Medical Center (S. Brierre, J. Byrne, T. Jagneaux, C. LeBlanc, K. Moreau, C. Thomas); Ochsner Clinic Foundation (S. Jain, D. Taylor, L. Seoane); Our Lady of the Lake Medical Center (C. Hebert, J. Thompson); Tulane Medical Center (F. Simeone, J. Fearon).
Clinical Coordinating Center: Massachusetts General Hospital and Harvard Medical School (*D. Schoenfeld, N. Dong, M. Guha, E. Hammond, P. Lazar, R. Morse, C. Oldmixon, N. Ringwood, E. Smoot, B.T. Thompson, R. Wilson).
National Heart, Lung, and Blood Institute: A. Harabin, S. Bredow, M. Waclawiw, G. Weinmann.
Data and Safety Monitoring Board: R. G. Spragg (chair), A. Slutsky, M. Levy, B. Markovitz, E. Petkova, C. Weijer.
Protocol Review Committee: J. Sznajder (chair), M. Begg, L. Gilbert-McClain E. Israel, J. Lewis, S. McClave, P. Parsons. *Principal investigator.
All authors meet the criteria for authorship based on the International Committee of Medical Journal Editors (ICMJE) criteria.
Compliance with ethical standards
Conflicts of interest
All authors declare that they have no conflict of interest to disclose.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
National Heart, Lung, and Blood Institute funded this follow-up study (N01HR56170, R01HL091760 and 3R01HL091760-02S1) and the ARDS Network trials (contracts HHSN268200536165C to HHSN268200536176C and HHSN268200536179C). The funder played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.
These ARDS Network trials are registered with ClinicalTrials.gov (NCT00434993, NCT00609180, NCT00609180 and NCT00883948, NCT00979121, NCT00719446).
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