title: The influence of hospitalization or intensive care unit admission on declines in health-related quality of life.
abstract: BACKGROUND
  Survivors of critical illness report impaired health-related quality of life (HRQoL) after hospital discharge, but the degree to which these impairments are attributable to critical illness is unknown.
  
  
  OBJECTIVE
  We sought to examine changes in HRQoL associated with an intensive care unit (ICU) stay and the differential association of type of hospitalization (critical illness versus noncritical illness) on changes in HRQoL.
  
  
  METHODS
  We identified 11,243 participants in the Ambulatory Care Quality Improvement Project (a multicenter randomized trial of Veterans conducted March 1997 to August 2000) completing at least two Medical Outcomes Study Short-Form 36 questionnaires over 2 years, and categorized patients by hospitalization status during the interval between measures. We used multiple linear regression with generalized estimating equations for analysis.
  
  
  RESULTS
  Our primary outcome was change in the Physical Component Summary score. Participants requiring hospitalization or ICU admission had significantly worse baseline HRQoL than those not hospitalized (P < 0.001). Compared with patients who were not hospitalized, follow-up Physical Component Summary scores were lower among non-ICU hospitalized patients and ICU patients (adjusted β-coefficient = -1.40 [95% confidence interval, -1.81, -0.99] and adjusted β-coefficient = -1.53 [95% confidence interval, -2.11, -0.95], respectively), with no difference between the two groups (P value = 0.80). Similar results were seen for the Mental Component Summary score and each of the Medical Outcomes Study Short-Form 36 subdomains.
  
  
  CONCLUSIONS
  Prehospital HRQoL is a significant determinant of HRQoL after hospitalization or ICU admission. Hospitalization is associated with increased risk of impairment in HRQoL after discharge, yet the overall magnitude of this reduction is small and similar between non-ICU hospitalized and critically ill patients.
authors.affiliation: 1 Health Services Research and Development, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Feemster
authors.forename: Colin R
authors.initials: CR
authors.lastname: Cooke
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Rubenfeld
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Hough
authors.forename: William J
authors.initials: WJ
authors.lastname: Ehlenbach
authors.forename: David H
authors.initials: DH
authors.lastname: Au
authors.forename: Vincent S
authors.initials: VS
authors.lastname: Fan
mesh_terms: D000368:Aged; D016638:Critical Illness / Q000523:psychology / Q000628:therapy*; D005260:Female; D006304:Health Status; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D017741:Survivors / Q000706:statistics & numerical data
keywords: cohort studies; critical illness; intensive care units; outcome assessment (health care); quality of life