title: Healthcare Resource Use and Costs in Long-Term Survivors of Acute Respiratory Distress Syndrome: A 5-Year Longitudinal Cohort Study.
abstract: OBJECTIVE
  To evaluate the time-varying relationship of annual physical, psychiatric, and quality of life status with subsequent inpatient healthcare resource use and estimated costs.
  
  
  METHODS
  Five-year longitudinal cohort study.
  
  
  METHODS
  Thirteen ICUs at four teaching hospitals.
  
  
  METHODS
  One hundred thirty-eight patients surviving greater than or equal to 2 years after acute respiratory distress syndrome.
  
  
  METHODS
  None.
  
  
  RESULTS
  Postdischarge inpatient resource use data (e.g., hospitalizations, skilled nursing, and rehabilitation facility stays) were collected via a retrospective structured interview at 2 years, with prospective collection every 4 months thereafter, until 5 years postacute respiratory distress syndrome. Adjusted odds ratios for hospitalization and relative medians for estimated episode of care costs were calculated using marginal longitudinal two-part regression. The median (interquartile range) number of inpatient admission hospitalizations was 4 (2-8), with 114 patients (83%) reporting greater than or equal to one hospital readmission. The median (interquartile range) estimated total inpatient postdischarge costs over 5 years were $58,500 ($19,700-157,800; 90th percentile, $328,083). Better annual physical and quality of life status, but not psychiatric status, were associated with fewer subsequent hospitalizations and lower follow-up costs. For example, greater grip strength (per 6 kg) had an odds ratio (95% CI) of 0.85 (0.73-1.00) for inpatient admission, with 23% lower relative median costs, 0.77 (0.69-0.87).
  
  
  CONCLUSIONS
  In a multisite cohort of long-term acute respiratory distress syndrome survivors, better annual physical and quality of life status, but not psychiatric status, were associated with fewer hospitalizations and lower healthcare costs.
authors.affiliation: 1National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. 2Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD. 3Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 4Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. 5Johns Hopkins University School of Medicine, Baltimore, MD. 6Department of Psychological Services, Kent State University, Kent, OH. 7Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 8Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD. 9Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. 10Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: A Parker
authors.initials: AP
authors.lastname: Ruhl
authors.forename: Minxuan
authors.initials: M
authors.lastname: Huang
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Colantuoni
authors.forename: Robert K
authors.initials: RK
authors.lastname: Lord
authors.forename: Victor D
authors.initials: VD
authors.lastname: Dinglas
authors.forename: Alexandra
authors.initials: A
authors.lastname: Chong
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Sepulveda
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Mendez-Tellez
authors.forename: Carl B
authors.initials: CB
authors.lastname: Shanholtz
authors.forename: Donald M
authors.initials: DM
authors.lastname: Steinwachs
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000191:economics* / Q000628:therapy; D017741:Survivors / Q000706:statistics & numerical data; D013997:Time Factors