Health policy and future planning for survivors of critical illness.
OBJECTIVE
Few health policy decisions directly address the needs of intensive care unit survivors. This review will assess some of the health system-level barriers to effective post-intensive care unit care and provide a framework for policy decisions directed at improving outcomes for survivors of critical illness.


RESULTS
Intensive care unit survivors incur significant morbidity, and account for enormous financial and opportunity costs. Despite our understanding of these burdens, relatively little is known about how to structure the healthcare system to improve outcomes after intensive care unit discharge. Several ongoing clinical trials will aid in system design and inform policy decisions. While we await more evidence, lessons learned in other disease states such as coronary care, acute stroke and traumatic brain injury can help us understand the attributes of a comprehensive longitudinal care model for critical illness. Future planning for the care of intensive care unit survivors should include defining the post-intensive care unit syndrome, expanding the use of information technology, educating providers, and developing a robust public health infrastructure that integrates acute and chronic care.


CONCLUSIONS
Advances in our understanding of the long-term outcomes of critical illness must be accompanied by healthcare system changes designed to meet the specific needs of intensive care unit survivors.
Kahn
Jeremy M
JM
Division of Pulmonary, Allergy & Critical Care, Leonard Davis Institute of Health Economics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, USA. jmkahn@mail.med.upenn.edu
Angus
Derek C
DC
D003266:Continuity of Patient Care / Q000458:organization & administration; D016638:Critical Illness; D006285:Health Planning / Q000191:economics / Q000458:organization & administration*; D006291:Health Policy; D006801:Humans; D007256:Information Systems / Q000458:organization & administration; D007362:Intensive Care Units; D008134:Long-Term Care / Q000458:organization & administration; D010346:Patient Care Management / Q000191:economics / Q000458:organization & administration*; D015980:Public Health Practice; D017741:Survivors