Patient-related factors associated with hospital discharge to a care facility after critical illness

Brian K. Gehlbach, Victor R. Salamanca, Joseph E. Levitt, Greg A. Sachs, Mary Kate Sweeney, Anne S. Pohlman, Jeff Charbeneau, Jerry A. Krishnan, Jesse B. Hall

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13 Scopus citations

Abstract

Background: Many critically ill patients are transferred to other care facilities instead of to home at hospital discharge. Objective: To identify patient-related factors associated with hospital discharge to a care facility after critical illness and to estimate the magnitude of risk associated with each factor. Methods Retrospective cohort study of 548 survivors of critical illness in a medical intensive care unit. Multivariable logistic regression was used to identify independent risk factors for discharge to a care facility. Only the first 72 hours of intensive care were analyzed. Results: Approximately one-quarter of the survivors of critical illness were discharged to a care facility instead of to home. This event occurred more commonly in older patients, even after adjustment for severity of illness and comorbid conditions (odds ratio [OR] 1.8 for patients ≥ 65 years of age vs patients < 65 years; 95% confidence interval [CI], 1.1-3.1; P= .02). The risk was greatest for patients who received mechanical ventilation (OR, 3.4; 95% CI, 2.0-5.8; P< .001) or had hospitalizations characterized by severe cognitive dysfunction (OR, 8.1; 95% CI, 1.3-50.6; P= .02) or poor strength and/or mobility (OR, 31.7; 95% CI, 6.4-157.3; P< .001). The model showed good discrimination (area under the curve, 0.82; 95% CI, 0.77-0.86). Conclusion: The model, which did not include baseline function or social variables, provided good discrimination between patients discharged to a care facility after critical illness and patients discharged to home. These results suggest that future research should focus on the debilitating effects of respiratory failure and on conditions with cognitive and neuromuscular sequelae.

Original languageEnglish (US)
Pages (from-to)378-386
Number of pages9
JournalAmerican Journal of Critical Care
Volume20
Issue number5
DOIs
StatePublished - Sep 1 2011

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ASJC Scopus subject areas

  • Critical Care

Cite this

Gehlbach, B. K., Salamanca, V. R., Levitt, J. E., Sachs, G. A., Sweeney, M. K., Pohlman, A. S., Charbeneau, J., Krishnan, J. A., & Hall, J. B. (2011). Patient-related factors associated with hospital discharge to a care facility after critical illness. American Journal of Critical Care, 20(5), 378-386. https://doi.org/10.4037/ajcc2011827