title: Survival experience of chronically critically ill patients.
abstract: Intensive care unit (ICU) patients were randomly assigned to either a traditional ICU or a special care unit (SCU) for chronically critically ill patients. The SCU used a low-technology, family-oriented environment, nursing case management, no physician house staff, and a shared governance model. In comparison, the ICU used high technology, limited family visiting, primary care nursing, and a bureaucratic management model. The survival experience of chronically critically ill patients in the two environments during hospitalization, as well as after hospital discharge, was examined. Using survival analytic techniques, the 1-year cumulative mortality for all patients in the study was found to be 59.9%. Risk of death was significantly lower after discharge than during hospitalization. Similar mortality experiences were found for SCU and ICU patients. Thus, the high-technology ICU environment did not produce better outcomes than the SCU environment.
authors.affiliation: Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA.
authors.forename: S
authors.initials: S
authors.lastname: Douglas
authors.forename: B J
authors.initials: BJ
authors.lastname: Daly
authors.forename: E B
authors.initials: EB
authors.lastname: Rudy
authors.forename: S M
authors.initials: SM
authors.lastname: Sereika
authors.forename: L
authors.initials: L
authors.lastname: Menzel
authors.forename: R
authors.initials: R
authors.lastname: Song
authors.forename: M A
authors.initials: MA
authors.lastname: Dyer
authors.forename: H D
authors.initials: HD
authors.lastname: Montenegro
mesh_terms: D000368:Aged; D019090:Case Management; D002908:Chronic Disease / Q000401:mortality* / Q000451:nursing*; D003422:Critical Care / Q000458:organization & administration*; D016638:Critical Illness / Q000401:mortality* / Q000451:nursing*; D003659:Decision Making, Organizational; D005190:Family; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D013677:Medical Laboratory Science; D008875:Middle Aged; D018802:Patient-Centered Care; D016019:Survival Analysis; D016896:Treatment Outcome