Chronically critically ill patients: health-related quality of life and resource use after a disease management intervention.
BACKGROUND
Chronically critically ill patients often have high costs of care and poor outcomes and thus might benefit from a disease management program.


OBJECTIVE
To evaluate how adding a disease management program to the usual care system affects outcomes after discharge from the hospital (mortality, health-related quality of life, resource use) in chronically critically ill patients.


METHODS
In a prospective experimental design, 335 intensive care patients who received more than 3 days of mechanical ventilation at a university medical center were recruited. For 8 weeks after discharge, advanced practice nurses provided an intervention that focused on case management and interdisciplinary communication to patients in the experimental group.


RESULTS
A total of 74.0% of the patients survived and completed the study. Significant predictors of death were age (P = .001), duration of mechanical ventilation (P = .001), and history of diabetes (P = .04). The disease management program did not have a significant impact on health-related quality of life; however, a greater percentage of patients in the experimental group than in the control group had "improved" physical health-related quality of life at the end of the intervention period (P = .02). The only significant effect of the intervention was a reduction in the number of days of hospital readmission and thus a reduction in charges associated with readmission.


CONCLUSIONS
The intervention was not associated with significant changes in any outcomes other than duration of readmission, but the supportive care coordination program could be provided without increasing overall charges.
Douglas
Sara L
SL
School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA. SLD4@case.edu
Daly
Barbara J
BJ
Kelley
Carol Genet
CG
O'Toole
Elizabeth
E
Montenegro
Hugo
H
D000368:Aged; D016638:Critical Illness; D019468:Disease Management; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D014481:United States