title: Health care resource use and costs of two-year survivors of acute lung injury. An observational cohort study.
abstract: BACKGROUND
  Survivors of acute lung injury (ALI) require ongoing health care resources after hospital discharge. The extent of such resource use, and associated costs, are not fully understood.
  
  
  OBJECTIVE
  For patients surviving at least 2 years after ALI, we evaluated cumulative 2-year inpatient admissions and related costs, and the association of patient- and intensive care unit-related exposures with these costs.
  
  
  METHODS
  Multisite observational cohort study in 13 intensive care units at four academic teaching hospitals evaluating 138 two-year survivors of ALI.
  
  
  RESULTS
  Two-year inpatient health care use data (i.e., admissions to hospitals, and skilled nursing and rehabilitation facilities) were collected for patients surviving at least 2 years, via (1) one-time retrospective structured interview with patient and/or proxy, (2) systematic medical record review for nonfederal study site hospitals, and (3) inpatient medical record review for non-study site hospitals, as needed for clarifying patient/proxy reports. Costs are reported in 2013 U.S. dollars. A total of 138 of 142 (97%) 2-year survivors completed the interview, with 111 (80%) reporting at least one inpatient admission during follow-up, for median (interquartile range [IQR]) estimated costs of $35,259 ($10,565-$81,166). Hospital readmissions accounted for 76% of costs. Among 12 patient- and intensive care unit-related exposures evaluated, baseline comorbidity and intensive care unit length of stay were associated with increased odds of incurring any follow-up inpatient costs. Having Medicare or Medicaid (vs. private insurance) was associated with median estimated costs that were 85% higher (relative median, 1.85; 95% confidence interval, 1.01-3.45; P=0.045).
  
  
  CONCLUSIONS
  In this multisite study of 138 two-year survivors of ALI, 80% had one or more inpatient admission, representing a median (IQR) estimated cost $35,259 ($10,565-$81,166) per patient and $6,598,766 for the entire cohort. Hospital readmissions represented 76% of total inpatient costs, and having Medicare or Medicaid before ALI was associated with increased costs. With the aging population and increasing comorbidity, these findings have important health policy implications for the care of critically ill patients.
authors.affiliation: 1 Outcomes after Critical Illness and Surgery Group.
authors.forename: A Parker
authors.initials: AP
authors.lastname: Ruhl
authors.forename: Robert K
authors.initials: RK
authors.lastname: Lord
authors.forename: Julia A
authors.initials: JA
authors.lastname: Panek
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Colantuoni
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Sepulveda
authors.forename: Alexandra
authors.initials: A
authors.lastname: Chong
authors.forename: Victor D
authors.initials: VD
authors.lastname: Dinglas
authors.forename: Carl B
authors.initials: CB
authors.lastname: Shanholtz
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: Donald M
authors.initials: DM
authors.lastname: Steinwachs
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D055371:Acute Lung Injury / Q000191:economics* / Q000401:mortality / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000639:trends*; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare; D010359:Patient Readmission / Q000191:economics; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D017741:Survivors; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: acute lung injury; critical care; health care costs; long-term survivors; patient readmission