title: A population-based observational study of intensive care unit-related outcomes. With emphasis on post-hospital outcomes.
abstract: BACKGROUND
  Many studies of critical illness outcomes have been restricted to short-term outcomes, selected diagnoses, and patients in one or a few intensive care units (ICUs).
  
  
  OBJECTIVE
  Evaluate a range of relevant outcomes in a population-based cohort of patients admitted to ICUs.
  
  
  METHODS
  Among all adult residents of the Canadian province of Manitoba admitted to ICUs over a 9-year period, we assessed ICU, hospital, 30-day, and 180-day mortality rates; ICU and hospital lengths-of-stay; Post-hospital use of hospital care, ICU care, outpatient physician care, medications, and home care; and Post-hospital residence location. We explored data stratified by age, sex, and separate categories of geocoded income for urban and rural residents. For Post-hospital use variables we compared ICU patients with those admitted to hospitals without the need for ICU care.
  
  
  RESULTS
  After ICU admission there was a high initial death rate, which declined between 30 and 180 days and thereafter remained at the lower value. Hospital mortality was 19.0%, with 21.7% dying within 6 months of ICU admission. Women had higher hospital mortality than men (20.8 vs. 17.8%; P = 0.0008). Among urban residents there was a steady gradient of declining hospital mortality with rising income (P < 0.0001). Mean ICU length of stay was 3.96 days, increasing 0.11 d/yr over the study period (P = 0.001); median ICU length of stay was 2.33 days and did not change over time. In the year after ICU care, 41% were rehospitalized, 10% were readmitted to an ICU, 98% had outpatient physician visits, 96% used prescription medications, and 27% used home care services. Although most of these parameters were statistically higher than for hospitalizations not requiring ICU care, differences were generally small. Among hospital survivors, 2.7% were discharged to chronic care facilities, with 2.5% living in such facilities 3 months later.
  
  
  CONCLUSIONS
  Post-hospital medical resource use among ICU survivors is substantial, although similar to that after non-ICU hospitalization. Although the fraction of survivors unable to live independently was small, a larger fraction required home care services. Identifying Post-hospital supports needed by ICU survivors can be useful for policy makers and others responsible for healthcare planning.
authors.affiliation: 1 Department of Internal Medicine.
authors.forename: Allan
authors.initials: A
authors.lastname: Garland
authors.forename: Kendiss
authors.initials: K
authors.lastname: Olafson
authors.forename: Clare D
authors.initials: CD
authors.lastname: Ramsey
authors.forename: Marina
authors.initials: M
authors.lastname: Yogendran
authors.forename: Randall
authors.initials: R
authors.lastname: Fransoo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality*; D016208:Databases, Factual; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D008350:Manitoba; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D012737:Sex Factors; D017741:Survivors / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult
keywords: health resources; intensive care units; long-term care; outcomes assessment; outcomes research