Published ahead of print on July 21, 2004, doi:10.1164/rccm.200403-260OC
© 2004 American Thoracic Society doi: 10.1164/rccm.200403-260OC
Critical Care Use during the Course of Serious IllnessDepartment of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania Correspondence and requests for reprints should be addressed to Theodore J. Iwashyna, M.D., Ph.D., c/o Nicholas Christakis, Department of Medicine, 100 Centrex, 3400 Spruce Street, Philadelphia, PA 19103. E-mail: iwashyna{at}alumni.Princeton.edu 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 in hospital charges and $1.4 billion 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.
Key Words: elderly • end-of-life care • intensive care use • health services research • Medicare claims This article has been cited by other articles:
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