SESSION TITLE: Cost and Quality Improvement
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 28, 2014 at 08:45 AM - 10:00 AM
PURPOSE: Healthcare accounts for a large proportion of the US economy and has been the focus of numerous cost control efforts. Within healthcare, critical care medicine is resource and cost intensive. The objective of this study is to describe and analyze costs, mortality and patterns associated with critical care medicine in the US.
METHODS: Admissions that involved critical care were identified in the Nationwide Inpatient Sample from the Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project (HCUP) database from 2001 to 2010. An admission was deemed to have included critical care if one of the following ICD-9 codes was listed: severe sepsis or septic shock (codes 785.52, 995.92); non-septic shock (785.50; 785.51, 785.59); mechanical ventilation (96.70, 96.71, 96.72); vasopressors (00.17); thrombolytics (99.10); or survived cardiac arrest (427.5). Outcomes included total hospital charges (adjusted by CPI to 2010 dollars and calculated as percent of gross domestic product [GDP]) and all-cause hospital mortality. Trends were analyzed with linear regression.
RESULTS: The number of admissions that included critical care increased from 348 per 100,000 US population in 2001 to 554 per 100,000 US population in 2010 (p<0.001). Adjusted charges for admissions that included critical care increased from 87.1 billion (12.9% of all US hospital charges; 0.8% of GDP) to 219 billion (17.3% of all US hospital charges; 1.7% of GDP) (p<0.001). All-cause hospital mortality significantly decreased from 30.3% in 2001 to 23.2% in 2010 (p<0.001). A critical care diagnosis was listed in 34.9% of hospital deaths in 2001, which increased to 53.7% in 2010 (p<0.001).
CONCLUSIONS: Admissions that involve critical care have significantly increased, while all-cause mortality for these admissions have decreased. Total hospital charges for admissions involving critical care have significantly increased. This data likely underestimates true critical care utilization since it is based on only a limited number of ICD-9 codes.
CLINICAL IMPLICATIONS: As of 2008, for the first time in the past decade, the majority of patients who die while hospitalized utilize critical care services at some point in their hospitalization. Total charges have outpaced growth of the GDP.
DISCLOSURE: The following authors have nothing to disclose: Viveka Boddipalli, Sean Smith, Richard Wunderink
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