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Predicting discharge to a long-term acute care hospital after admission to an intensive care unit.
Am J Crit Care. 2014 Jul;23(4):e46-53
Authors: Szubski CR, Tellez A, Klika AK, Xu M, Kattan MW, Guzman JA, Barsoum WK
Abstract
BACKGROUND: Long-term acute care hospitals are an option for patients in intensive care units who require prolonged care after an acute illness. Predicting use of these facilities may help hospitals improve resource management, expenditures, and quality of care delivered in intensive care.
OBJECTIVE: To develop a predictive tool for early identification of intensive care patients with increased probability of transfer to such a hospital.
METHODS: Data on 1967 adults admitted to intensive care at a tertiary care hospital between January 2009 and June 2009 were retrospectively reviewed. The prediction model was developed by using multiple ordinal logistic regression. The model was internally validated via the bootstrapping technique and externally validated with a control cohort of 950 intensive care patients.
RESULTS: Among the study group, 146 patients (7.4%) were discharged to long-term acute care hospitals and 1582 (80.4%) to home or other care facilities; 239 (12.2%) died in the intensive care unit. The final prediction algorithm showed good accuracy (bias-corrected concordance index, 0.825; 95% CI, 0.803-0.845), excellent calibration, and external validation (concordance index, 0.789; 95% CI, 0.754-0.824). Hypoalbuminemia was the greatest potential driver of increased likelihood of discharge to a long-term acute care hospital. Other important predictors were intensive care unit category, older age, extended hospital stay before admission to intensive care, severe pressure ulcers, admission source, and dependency on mechanical ventilation.
CONCLUSIONS: This new predictive tool can help estimate on the first day of admission to intensive care the likelihood of a patient's discharge to a long-term acute care hospital.
PMID: 24986179 [PubMed - in process]