scholarly journals Outcomes of Patients Who Have Do Not Resuscitate Status prior to Being Admitted to an Intensive Care Unit

Scientifica ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Debjit Saha ◽  
Carlos Moreno ◽  
Marc Csete ◽  
Elizabeth Kury Perez ◽  
Luigi Cubeddu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Acute Care ◽  
Care Facility ◽  
Limited Resources ◽  
Apache Ii Score ◽  
Do Not Resuscitate ◽  
Acute Care Facility ◽  
Intensive Intervention ◽  
Post Acute Care

Admission of patients who have do not resuscitate (DNR) status to an intensive care unit (ICU) is potentially a misallocation of limited resources to patients who may neither need nor want intensive care. Yet, patients who have DNR status are often admitted to the ICU. This is a retrospective review of patients who had a valid DNR status at the time that they were admitted to an ICU in a single hospital over an eighteen-month period. Thirty-five patients met the criteria for inclusion in the study. The primary reasons for admission to the ICU were respiratory distress (54.2%) and sepsis (45.7%). Sixteen (45.7%) of the patients died, compared to a 5.4% mortality rate for all patients admitted to our ICU during this period (p<0.001). APACHE II score was a significant predictor of mortality (18.5 ± 1.3 alive and 23.4 ± 1.4 dead;p=0.038). Of the 19 patients discharged alive, 9 were discharged home, 5 to hospice, and 4 to a post-acute care facility.Conclusions.Patients who have DNR status and are admitted to the ICU have a higher mortality than other ICU patients. Those who survive have a high likelihood of being discharged to hospice or a post-acute care facility. The value of intensive intervention for these patients is not supported by these results. Only a minority of patients were seen by palliative care and chaplain teams, services which the literature supports as valuable for DNR patients. Our study supports the need for less expensive and less intensive but more appropriate resources for patients and families who have chosen DNR status.

scholarly journals Hospital to Post-Acute Care Facility Transfers: Identifying Targets for Information Exchange Quality Improvement

2017 ◽  
Vol 18 (1) ◽  
pp. 70-73 ◽  
Author(s):  
Christine D. Jones ◽  
Ethan Cumbler ◽  
Benjamin Honigman ◽  
Robert E. Burke ◽  
Rebecca S. Boxer ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Acute Care ◽  
Information Exchange ◽  
Care Facility ◽  
Acute Care Facility ◽  
Post Acute Care

111 Misaligned Incentives for Lumbar Spine Surgery in the Bundled Payment for Care Initiative

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 223-223
Author(s):  
Joseph E Tanenbaum ◽  
Dominic Pelle ◽  
Edward C Benzel ◽  
Michael P Steinmetz ◽  
Thomas Mroz
Keyword(s):  
Acute Care ◽  
Lumbar Fusion ◽  
Hospital Costs ◽  
Care Facility ◽  
Thoracolumbar Fracture ◽  
Acute Care Facility ◽  
Patient Demographics ◽  
Episode Of Care ◽  
Hospital Characteristics ◽  
Post Acute Care

Abstract INTRODUCTION Under the Bundled Payments for Care Initiative (BPCI), Medicare reimburses for lumbar fusion without adjusting for the patient's underlying pathology. We compared the hospital resource use of two lumbar fusion cohorts that BPCI groups into the same payment bundle: patients with spondylolisthesis and patients with thoracolumbar fracture. METHODS With BPCI, hospitals are reimbursed for a lumbar fusion episode of care if patients are assigned diagnosis related group (DRG) 459 or 460. Vertebroplasty and kyphoplasty use different DRGs. National Inpatient Sample data from 2013 were queried to identify all patients that underwent lumbar fusion to treat a primary diagnosis of thoracolumbar fracture or spondylolisthesis and that were assigned DRG 459 or 460. Multivariable linear and logistic regression were used to compare length of hospital stay (LOS), direct hospital costs, and odds of discharge to a post-acute care facility for thoracolumbar fracture patients and spondylolisthesis patients. All models adjusted for patient demographics, 29 comorbidities, and hospital characteristics. The complex survey design of the NIS was taken into account in all models. RESULTS >After adjusting for patient demographics, insurance status, hospital characteristics, and 29 comorbidities, spondylolisthesis patients had a mean LOS that was 36% shorter (95% CI 26% - 44%, P< 0.0001), a mean cost that was 13% less (95% CI 3.7% - 21%, P< 0.0001), and had 3.6 times greater odds of being discharged home (95% CI 2.5 5.4, P< 0.0001) than thoracolumbar fracture patients. CONCLUSION Under the proposed DRG-based BPCI, hospitals would be reimbursed the same amount for lumbar fusion regardless of whether a patient had spondylolisthesis or thoracolumbar fracture. However, compared with fusion for spondylolisthesis, fusion for thoracolumbar fracture was associated with longer LOS, greater direct hospital costs, and increased likelihood of being discharged to a post-acute care facility. Our findings suggest that the BPCI episode of care for lumbar fusion dis-incentivizes treating trauma patients.

scholarly journals A predictive score to identify hospitalized patients' risk of discharge to a post-acute care facility

2008 ◽  
Vol 8 (1) ◽  
Author(s):  
Martine Louis Simonet ◽  
Michel P Kossovsky ◽  
Pierre Chopard ◽  
Philippe Sigaud ◽  
Thomas V Perneger ◽  
...  
Keyword(s):  
Acute Care ◽  
Care Facility ◽  
Hospitalized Patients ◽  
Predictive Score ◽  
Acute Care Facility ◽  
Post Acute Care
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