Characteristics, Outcomes, and Cost Patterns of High-Cost Patients in the Intensive Care Unit

Peter M Reardon; Shannon M Fernando; Sasha Van Katwyk; Kednapa Thavorn; Daniel Kobewka; Peter Tanuseputro; Erin Rosenberg; Cynthia Wan; Brandi Vanderspank-Wright; Dalibor Kubelik; Rose Anne Devlin; Christopher Klinger; Kwadwo Kyeremanteng

doi:10.1155/2018/5452683

Characteristics, Outcomes, and Cost Patterns of High-Cost Patients in the Intensive Care Unit

Crit Care Res Pract. 2018 Sep 2:2018:5452683. doi: 10.1155/2018/5452683. eCollection 2018.

Authors

Peter M Reardon^{1

2}, Shannon M Fernando^{1

2}, Sasha Van Katwyk³, Kednapa Thavorn^{3

4

5}, Daniel Kobewka^{3

6}, Peter Tanuseputro^{3

4

5

6

7}, Erin Rosenberg¹, Cynthia Wan⁸, Brandi Vanderspank-Wright^{3

9}, Dalibor Kubelik^{1

3

10}, Rose Anne Devlin¹¹, Christopher Klinger¹², Kwadwo Kyeremanteng^{1

3

7}

Affiliations

¹ Division of Critical Care Medicine, University of Ottawa, Ottawa, ON, Canada.
² Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
³ Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁴ School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.
⁵ Institute for Clinical and Evaluative Sciences, University of Ottawa, Ottawa, ON, Canada.
⁶ Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁷ Division of Palliative Care Medicine, University of Ottawa, Ottawa, ON, Canada.
⁸ School of Psychology, University of Ottawa, Ottawa, ON, Canada.
⁹ School of Nursing, University of Ottawa, Ottawa, ON, Canada.
¹⁰ Division of Vascular Surgery, University of Ottawa, Ottawa, ON, Canada.
¹¹ Department of Economics, University of Ottawa, Ottawa, ON, Canada.
¹² Factor-Inwentash, Faculty of Social Work, University of Toronto, Toronto, ON, Canada.

Abstract

Background: ICU care is costly, and there is a large variation in cost among patients.

Methods: This is an observational study conducted at two ICUs in an academic centre. We compared the demographics, clinical data, and outcomes of the highest decile of patients by total costs, to the rest of the population.

Results: A total of 7,849 patients were included. The high-cost group had a longer median ICU length of stay (26 versus 4 days, P < 0.001) and amounted to 49% of total costs. In-hospital mortality was lower in the high-cost group (21.1% versus 28.4%, P < 0.001). Fewer high-cost patients were discharged home (23.9% versus 45.2%, P < 0.001), and a large proportion were transferred to long-term care (35.1% versus 12.1%, P < 0.001). Patients with younger age or a diagnosis of subarachnoid hemorrhage, acute respiratory failure, or complications of procedures were more likely to be high cost.

Conclusions: High-cost users utilized half of the total costs. While cost is associated with LOS, other drivers include younger age or admission for respiratory failure, subarachnoid hemorrhage, or after a procedural complication. Cost-reduction interventions should incorporate strategies to optimize critical care use among these patients.