Outcomes after Rehospitalization at the Same Hospital or a Different Hospital Following Critical Illness.
Intensive care unit (ICU) patients who receive mechanical ventilation are at high risk for early rehospitalization. Given the medical complexity of these patients, a lack of continuity of care may adversely affect their outcomes during rehospitalization.



To determine whether outcomes differ for patients who are rehospitalized at a different hospital versus the hospital of their index ICU stay.



We conducted a retrospective cohort study of mechanically ventilated ICU patients rehospitalized within 30 days in New York State hospitals between 2008 and 2013.



We measured frequency of rehospitalization at a different hospital, mortality, length of stay, and costs during rehospitalization. Of 26,947 mechanically ventilated ICU patients rehospitalized within 30 days of discharge, 8,443 (31.3%) were rehospitalized at a different hospital than that of the index ICU stay. For patients at a different hospital, 13.7% died during rehospitalization versus 11.1% who died at the index hospital (adjusted rate ratio [aRR], 1.11; 95% confidence interval [CI], 1.03-1.20; P = 0.009). Patients who died at a different hospital had shorter length of stay (aRR, 0.80; 95% CI, 0.70-0.92; P = 0.001) and decreased costs (adjusted mean difference, -$9,632.73; 95% CI, -$16,387.60 to -$2,877.88; P = 0.005), whereas survivors of rehospitalization at a different hospital had a modest increase in length of stay (aRR, 1.06; 95% CI, 1.01-1.11; P = 0.009) and increased costs of care (adjusted mean difference, $1,665.34; 95% CI, $602.12-$2,728.56; P = 0.002).



Almost one-third of mechanically ventilated critically ill patients were rehospitalized at a different hospital than that of the index ICU stay. This care discontinuity was associated with increased mortality.
1 Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York.|2 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
May
M
Hua
3 Department of Medicine and.|4 Department of Epidemiology and Population Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
Michelle Ng
MN
Gong
1 Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York.
Andrea
A
Miltiades
1 Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York.|5 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; and.|6 Department of Anesthesia and.|7 Department of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
Hannah
H
Wunsch
D000368:Aged; D015331:Cohort Studies; D003422:Critical Care / Q000191:economics / Q000706:statistics & numerical data*; D016638:Critical Illness; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D009518:New York; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D012121:Respiration, Artificial / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies
continuity of patient care; critical illness; hospital readmissions; outcomes research