The influence of clinical variables on the risk of developing chronic conditions in ICU survivors.

PURPOSE: To assess the association of clinical variables and the development of specified chronic conditions in ICU survivors. MATERIALS AND METHODS: A retrospective cohort study, combining a national health insurance claims database and a national quality registry for ICUs. Claims data from 2012 to 2014 were combined with clinical data of patients admitted to an ICU during 2013. To assess the association of clinical variables (ICU length of stay, mechanical ventilation, acute physiology score, reason for ICU admission, mean arterial pressure score and glucose score) and the development of chronic conditions (i.e. heart diseases, COPD or asthma, Diabetes mellitus type II, depression and kidney diseases), logistic regression was used. RESULTS: 49,004 ICU patients were included. ICU length of stay was associated with the development of heart diseases, asthma or COPD and depression. The reason for ICU admission was an important risk factor for the development of all chronic conditions with adjusted ORs ranging from 2.05 (CI 1.56; 2.69) for kidney diseases to 5.14 (CI 3.99; 6.62) for depression. CONCLUSIONS: Clinical variables, especially the reason for ICU admission, are associated with the development of chronic conditions after ICU discharge. Therefore, these clinical variables should be considered when organizing follow-up care for ICU survivors.

Determinants of Post-acute Care Costs in Acutely Hospitalized Older Adults: The Hospital-ADL Study.

OBJECTIVES: After hospitalization, many older adults need post-acute care, including rehabilitation or home care. However, post-acute care expenses can be as high as the costs for the initial hospitalization. Detailed information on monthly post-acute health care expenditures and the characteristics of patients that make up for a large share of these expenditures is scarce. We aimed to calculate costs in acutely hospitalized older patients and identify patient characteristics that are associated with high post-acute care costs. DESIGN: Prospective multicenter cohort study (between October 2015 and June 2017). SETTING AND PARTICIPANTS: 401 acutely hospitalized older persons from internal medicine, cardiology, and geriatric wards. MEASUREMENTS: Our primary outcome was mean post-acute care costs within 90 days postdischarge. Post-acute care costs included costs for unplanned readmissions, home care, nursing home care, general practice, and rehabilitation care. Three costs categories were defined: low [0-50th percentile (p0-50)], moderate (p50-75), and high (p75-100). Multinomial logistic regression analyses were conducted to assess the associations between costs and frailty, functional impairment, health-related quality of life, cognitive impairment, and depressive symptoms. RESULTS: Costs were distributed unevenly in the population, with the top 10.0% (n = 40) accounting for 52.1% of total post-acute care costs. Mean post-acute care costs were €4035 [standard deviation (SD) 4346] or $4560 (SD 4911). Frailty [odds ratio (OR) 3.44, 95% confidence interval (CI) 1.78-6.63], functional impairment (OR 1.80, 95% CI 1.03-3.16), and poor health-related quality of life (OR 1.89, 95% CI 1.09-3.28) at admission were associated with classification in the high-cost group, compared with the low-cost group. CONCLUSIONS/IMPLICATIONS: Post-acute care costs are substantial in a small portion of hospitalized older adults. Frailty, functional impairment, and poor health-related quality of life are associated with higher post-acute care costs and may be used as an indicator of such costs in practice.

Feasibility of Muscle Activity Assessment With Surface Electromyography During Bed Cycling Exercise In Intensive Care Unit Patients.

INTRODUCTION: Intensive care unit (ICU) patients often develop weakness. Rehabilitation is initiated early to prevent physical deterioration, but knowledge of optimal training schedules is lacking. A reliable method to assess muscle activity during exercise is needed. In this study we explored the feasibility of electrical activity measurement by surface electromyography (sEMG) during bed cycling in ICU patients. METHODS: SEMG was performed in 9 ICU patients and 6 healthy controls. A standardized 1-minute incremental resistance bedside cycle ergometer protocol was used. RESULTS: The median cycle time was 5.3 minutes in patients and 12.0 minutes in controls. The maximum sEMG increased in both groups; the minimal sEMG activity remained the same in patients, whereas an increase in the control group was found. DISCUSSION: sEMG is feasible and can detect muscle activity during bed cycling in ICU patients. It may be a useful monitoring tool. Repeated measurements could possibly provide information on the effects of training. Muscle Nerve 58: 688-693, 2018.

Healthcare costs of ICU survivors are higher before and after ICU admission compared to a population based control group: A descriptive study combining healthcare insurance data and data from a Dutch national quality registry.

PURPOSE: To identify subgroups of ICU patients with high healthcare utilization for healthcare expenditure management purposes such as prevention and targeted care. MATERIALS AND METHODS: We conducted a descriptive cohort study, combining a national health insurance claims database and a national quality registry database for ICUs. Claims data in the timeframe 2012-2014 were combined with the clinical data of ICU patients admitted to an ICU during 2013. A population based control group was created based on the ICU population. RESULTS: 56,760 ICU patients and 75,232 controls from the general population were included. Median healthcare costs per day alive for the ICU population were significantly higher during the year before (€8.9 (IQR €2.4; €32.1)) and the year after ICU admission (€15.4 (IQR €5.4; €51.2)) compared to the control group ((€2.8 (IQR €0.7; €8.8) and €3.1 (IQR €0.8; €10.1)). ICU patients with more chronic conditions had significantly higher healthcare costs before and after ICU admission compared to ICU patients with less chronic conditions. CONCLUSIONS: ICU patients have three to five times higher healthcare costs per day alive compared to a control population. Our findings can be used to optimize the healthcare trajectories of ICU patients with high healthcare utilization after discharge.

Reported burden on informal caregivers of ICU survivors: a literature review.

BACKGROUND: Critical illness and the problems faced after ICU discharge do not only affect the patient, it also negatively impacts patients' informal caregivers. There is no review which summarizes all types of burden reported in informal caregivers of ICU survivors. It is important that the burdens these informal caregivers suffer are systematically assessed so the caregivers can receive the professional care they need. We aimed to provide a complete overview of the types of burdens reported in informal caregivers of adult ICU survivors, to make recommendations on which burdens should be assessed in this population, and which tools should be used to assess them. METHOD: We performed a systematic search in PubMed and CINAHL from database inception until June 2014. All articles reporting on burdens in informal caregivers of adult ICU survivors were included. Two independent reviewers used a standardized form to extract characteristics of informal caregivers, types of burdens and instruments used to assess these burdens. The quality of the included studies was assessed using the Newcastle-Ottawa and the PEDro scales. RESULTS: The search yielded 2704 articles, of which we included 28 in our review. The most commonly reported outcomes were psychosocial burden. Six months after ICU discharge, the prevalence of anxiety was between 15% and 24%, depression between 4.7% and 36.4% and post-traumatic stress disorder (PTSD) between 35% and 57.1%. Loss of employment, financial burden, lifestyle interference and low health-related quality of life (HRQoL) were also frequently reported. The most commonly used tools were the Hospital Anxiety and Depression Scale (HADS), Centre for Epidemiological Studies-Depression questionnaire, and Impact of Event Scale (IES). The quality of observational studies was low and of randomized studies moderate to fair. CONCLUSIONS: Informal caregivers of ICU survivors suffer a substantial variety of burdens. Although the quality of the included studies was poor, there is evidence that burden in the psychosocial field is most prevalent. We suggest screening informal caregivers of ICU survivors for anxiety, depression, PTSD, and HRQoL using respectively the HADS, IES and Short Form 36 and recommend a follow-up period of at least 6 months.