Composite outcomes of chronically critically ill patients 4 months after hospital discharge.
BACKGROUND
Data on likely postdischarge outcomes are important for decision making about chronically critically ill patients. It seems reasonable to categorize outcomes into "better" or overall desirable states and "worse" or generally undesirable states. Survival, being at home, and being cognitively intact are commonly identified as important to quality of life and thus may be combined to describe composite outcome states.


OBJECTIVE
To categorize postdischarge outcome states of chronically critically ill patients and identify predictors of better and worse states.


METHODS
Reanalysis of data from a trial of a disease management program for chronically critically ill patients. Two composite outcomes were created: (1) the "better" outcome: no cognitive impairment at 2 months after discharge and alive and at home at 4 months (ie, met all 3 criteria), and (2) the "worse" outcome: cognitive impairment 2 months after discharge, or death after discharge, or not living at home 4 months after discharge (ie, met at least 1 of these criteria).


RESULTS
Of 218 patients not requiring ventilatory support at discharge, 111 (50.9%) had a better outcome. Of 159 patients who were cognitively intact at discharge, 111 (69.8%) had a better outcome. Of the 39 patients who required ventilatory support at discharge, only 1 (3%) achieved the better outcome. Of 98 patients who were cognitively impaired at discharge, only 29 (30%) had the better outcome.


CONCLUSIONS
Need for mechanical ventilatory support and persistent cognitive impairment at discharge were associated with worse outcomes 4 months after discharge.
Daly
Barbara J
BJ
School of Nursing, Case Western Reserve University, Cleveland, Ohio 44106-4904, USA. barbara.daly@case.edu
Douglas
Sara L
SL
Gordon
Nahida H
NH
Kelley
Carol G
CG
O'Toole
E
E
Montenegro
Hugo
H
Higgins
Patricia
P
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003072:Cognition Disorders / Q000209:etiology*; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy; D003657:Decision Making; D005260:Female; D006304:Health Status; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012121:Respiration, Artificial / Q000009:adverse effects*; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome