Chronically critically ill patients: health-related quality of life and resource use after a disease management intervention

Abstract

Background: Chronically critically ill patients often have high costs of care and poor outcomes and thus might benefit from a disease management program.

Objectives: To evaluate how adding a disease management program to the usual care system affects outcomes after discharge from the hospital (mortality, health-related quality of life, resource use) in chronically critically ill patients.

Methods: In a prospective experimental design, 335 intensive care patients who received more than 3 days of mechanical ventilation at a university medical center were recruited. For 8 weeks after discharge, advanced practice nurses provided an intervention that focused on case management and interdisciplinary communication to patients in the experimental group.

Results: A total of 74.0% of the patients survived and completed the study. Significant predictors of death were age (P = .001), duration of mechanical ventilation (P = .001), and history of diabetes (P = .04). The disease management program did not have a significant impact on health-related quality of life; however, a greater percentage of patients in the experimental group than in the control group had "improved" physical health-related quality of life at the end of the intervention period (P = .02). The only significant effect of the intervention was a reduction in the number of days of hospital readmission and thus a reduction in charges associated with readmission.

Conclusion: The intervention was not associated with significant changes in any outcomes other than duration of readmission, but the supportive care coordination program could be provided without increasing overall charges.

Figure 1

Distribution of the sample.

Figure 2

Survival over time after discharge from the hospital for patients in the experimental (Exp) and control groups (n = 334).

Figure 3

Comparison of health-related quality of life (physical) over time for experimental (n = 141) and control (n = 57) groups. Data are reported for those patients who had no cognitive impairment at hospital discharge and had completed the Short Form 8.

Figure 4

Comparison of categories of change in patients’ health-related quality-of-life score during the study period for patients in the experimental group (n = 179) and patients in the control group (n = 65). Sample sizes represent patients who had no cognitive impairment at discharge (experimental = 136 and control = 45) plus those who died during the study period (experimental = 43 and control = 20). ^aSolid black represents the percentage of patients who died, dropped out of the study, or were lost to follow-up (did not provide data).