Association between unmet medication needs after hospital discharge and readmission or death among acute respiratory failure survivors: the addressing post-intensive care syndrome (APICS-01) multicenter prospective cohort study

Critical Care

Somnath Bose¹  Valerie Banner-Goodspeed¹  Tom Greene²  Ramona O. Hopkins³  Narjes Akhlaghi⁴  Dale M. Needham⁵  Alison E. Turnbull⁵  Victor D. Dinglas⁵  Danielle Groat⁶  Sarah Beesley⁷  Samuel M. Brown⁸  Mustafa Mir-Kasimov⁹  Carla M. Sevin^1,10  James C. Jackson^1,10 

[1] Beth Israel Deaconess Medical Center, Boston, MA, USA;Biostatistics and Epidemiology, University of Utah, Salt Lake City, UT, USA;Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, UT, USA;Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT, USA;Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA;Outcomes After Critical Illness and Surgery (OACIS) Group and Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA;Pulmonary and Critical Care Medicine, Intermountain Medical Center, Salt Lake City, UT, USA;Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, UT, USA;Pulmonary and Critical Care Medicine, Intermountain Medical Center, Salt Lake City, UT, USA;Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT, USA;Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, UT, USA;Pulmonary and Critical Care Medicine, Intermountain Medical Center, Salt Lake City, UT, USA;Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT, USA;Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, UT, USA;Shock Trauma ICU, Intermountain Medical Center, 5121 S. Cottonwood Street, 84107, Murray, UT, USA;Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT, USA;Salt Lake City Veterans Administration, Salt Lake City, UT, USA;Vanderbilt University Medical Center, Nashville, TN, USA;

关键词: Acute respiratory failure;    Long-term outcomes;    Discharge planning;    Health services research;   

DOI  :  10.1186/s13054-021-03848-3

来源: Springer

【 摘 要 】

IntroductionSurvivors of acute respiratory failure (ARF) commonly experience long-lasting physical, cognitive, and/or mental health impairments. Unmet medication needs occurring immediately after hospital discharge may have an important effect on subsequent recovery.Methods and analysisIn this multicenter prospective cohort study, we enrolled ARF survivors who were discharged directly home from their acute care hospitalization. The primary exposure was unmet medication needs. The primary outcome was hospital readmission or death within 3 months after discharge. We performed a propensity score analysis, using inverse probability weighting for the primary exposure, to evaluate the exposure–outcome association, with an a priori sample size of 200 ARF survivors.ResultsWe enrolled 200 ARF survivors, of whom 107 (53%) were female and 77 (39%) were people of color. Median (IQR) age was 55 (43–66) years, APACHE II score 20 (15–26) points, and hospital length of stay 14 (9–21) days. Of the 200 participants, 195 (98%) were in the analytic cohort. One hundred fourteen (57%) patients had at least one unmet medication need; the proportion of medication needs that were unmet was 6% (0–15%). Fifty-six (29%) patients were readmitted or died by 3 months; 10 (5%) died within 3 months. Unmet needs were not associated (risk ratio 1.25; 95% CI 0.75–2.1) with hospital readmission or death, although a higher proportion of unmet needs may have been associated with increased hospital readmission (risk ratio 1.7; 95% CI 0.96–3.1) and decreased mortality (risk ratio 0.13; 95% CI 0.02–0.99).DiscussionUnmet medication needs are common among survivors of acute respiratory failure shortly after discharge home. The association of unmet medication needs with 3-month readmission and mortality is complex and requires additional investigation to inform clinical trials of interventions to reduce unmet medication needs.Study registration number: NCT03738774. The study was prospectively registered before enrollment of the first patient.

【 授权许可】

CC BY