Suchergebnisse

IntroductionMore patients are surviving critical illness, with a growing understanding that transition to survivorship needs to be managed in primary care. In Wales, however, survivors' comprehensive healthcare resource utilisation (HRU) has not been studied in detail.
AimTo investigate the levels and predictors of HRU of critical illness survivors in Wales.
MethodsWe used the SAIL Databank to identify survivors and characterise their HRU. We fitted Poisson models for HRU during one year after intensive care unit (ICU) stay, adjusted for follow-up length within that year, HRU in the previous year, modified Charlson Comorbidity Index (CCI), age group, and gender.
ResultsWe identified 56,722 patients. The median age was 66 years (IQR=52-76), 46.3% were female, and 39.0% had high comorbidity (CCI≥10). More patients lived in the more deprived areas. Patients had medians of 29 (0-51) visits to general practitioners (GP), 5 (2-10) outpatient visits, 17 (5-63) days for length of hospital stay (LOS), and a mean of 0.89 emergency department (ED) attendances. Older patients had more GP visits (incidence rate ratio, IRRs, ranged from 1.1 to 1.2) and outpatient visits (1.1), greater LOS (1.2 to 1.7), but fewer ED visits (0.72 to 0.65). Higher CCI was associated with greater HRU (GP [1.19, 1.20], ED [1.34, 1.42], outpatient [1.50, 1.52], LOS [1.24, 1.6]). Higher socioeconomic deprivation was associated with more ED visits (IRR=1.2 [1.17, 1.25] between the most and the least deprived areas).
ConclusionCritical care survivors use significant primary healthcare resources following their ICU stay. Predictors of long-term mortality [1] also influence HRU. The fewer ED visits in the older patients needs further evaluation.
1. Szakmany T et al. Crit Care Med. 2019 Jan;47(1):15–22.

IntroductionCritical Care is a specialty in medicine providing a service for severely ill and high-risk patients who, due to the nature of their condition, may require long periods recovering after discharge. Consequently, focus on the routine data collection carried out in Intensive Care Units (ICUs) leads to reporting that is confined to the critical care episode and is typically insensitive to variation in individual patient pathways through critical care to recovery.
A resource which facilitates efficient research into interactions with healthcare services surrounding critical admissions, capturing the complete patient's healthcare trajectory from primary care to non-acute hospital care prior to ICU, would provide an important longer-term perspective for critical care research.
ObjectiveTo describe and apply a reproducible methodology that demonstrates how both routine administrative and clinically rich critical care data sources can be integrated with primary and secondary healthcare data to create a single dataset that captures a broader view of patient care.
MethodTo demonstrate the INTEGRATE methodology, it was applied to routine administrative and clinical healthcare data sources in the Secure Anonymised Data Linking (SAIL) Databank to create a dataset of patients' complete healthcare trajectory prior to critical care admission. SAIL is a national, data safe haven of anonymised linkable datasets about the population of Wales.
ResultsWhen applying the INTEGRATE methodology in SAIL, between 2010 and 2019 we observed 91,582 critical admissions for 76,019 patients. Of these, 90,632 (99%) had an associated non-acute hospital admission, 48,979 (53%) hadan emergency admission, and 64,832 (71%) a primary care interaction in the week prior to the critical care admission.
ConclusionThis methodology, at population scale, integrates two critical care data sources into a single dataset together with data sources on healthcare prior to critical admission, thus providing a key research asset to study critical care pathways.