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. 2024 Sep 1;52(9):1333-1343.
doi: 10.1097/CCM.0000000000006335. Epub 2024 May 23.

Utilization and Outcomes in U.S. ICU Hospitalizations

Sneha Kannan  1   2   3 , Mia Giuriato  3 , Zirui Song  3   4   5
Affiliations

Utilization and Outcomes in U.S. ICU Hospitalizations

Sneha Kannan et al. Crit Care Med. .

Abstract

Objectives: Despite its importance, detailed national estimates of ICU utilization and outcomes remain lacking. We aimed to characterize trends in ICU utilization and outcomes over a recent 12-year period in the United States.

Design/setting: In this longitudinal study, we examined hospitalizations involving ICU care ("ICU hospitalizations") alongside hospitalizations not involving ICU care ("non-ICU hospitalizations") among traditional Medicare beneficiaries using 100% Medicare part A claims data and commercial claims data for the under 65 adult population from 2008 to 2019.

Patients/interventions: There were 18,313,637 ICU hospitalizations and 78,501,532 non-ICU hospitalizations in Medicare, and 1,989,222 ICU hospitalizations and 16,732,960 non-ICU hospitalizations in the commercially insured population.

Measurements and main results: From 2008 to 2019, about 20% of Medicare hospitalizations and 10% of commercial hospitalizations involved ICU care. Among these ICU hospitalizations, length of stay and ICU length of stay decreased on average. Mortality and hospital readmissions on average also decreased, and they decreased more among ICU hospitalizations than among non-ICU hospitalizations, for both Medicare and commercially insured patients. Both Medicare and commercial populations experienced a growth in shorter ICU hospitalizations (between 2 and 7 d in length), which were characterized by shorter ICU stays and lower mortality. Among these short hospitalizations in the Medicare population, for common clinical diagnoses cared for in both ICU and non-ICU settings, patients were increasingly triaged into an ICU during the study period, despite being younger and having shorter hospital stays.

Conclusions: ICUs are used in a sizeable share of hospitalizations. From 2008 to 2019, ICU length of stay and mortality have declined, while short ICU hospitalizations have increased. In particular, for clinical conditions often managed both within and outside of an ICU, shorter ICU hospitalizations involving younger patients have increased. Our findings motivate opportunities to better understand ICU utilization and to improve the value of ICU care for patients and payers.

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Conflict of interest statement

Dr. Kannan’s institution received funding from the National Heart, Lung, and Blood Institute, the National Institute on Aging (NIA), and the Arnold Foundation; she received support for article research from the Arnold Foundation. Drs. Kannan and Song received support for article research from the National Institutes of Health. Dr. Song’s institution received funding from the NIA (P01-AG032952) and Arnold Ventures (grant number: 2004402); she received funding from Research Triangle Institute, Google Ventures, and Greylock McKinnon Associates. Dr. Giuriato has disclosed that she does not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.. Rate of ICU and Non-ICU Hospitalizations in the Medicare and Commercial Populations, 2008–2019
This Figure shows rates of ICU and non-ICU hospitalizations per 1,000 beneficiaries using 2008–2019 traditional (fee-for-service) Medicare 100% inpatient claims data provided by the Centers of Medicare & Medicaid Services (CMS) and 2008–2019 inpatient claims from the MarketScan Commercial Claims and Encounters database.
See this image and copyright information in PMC

References

    1. Critical Care Statistics. Society of Critical Care Medicine. https://www.sccm.org/Communications/Critical-Care-Statistics. Updated 2019. Accessed October 20, 2023.
    1. Halpern NA, Pastores SM. Critical Care Medicine Beds, Use, Occupancy, and Costs in the United States: A Methodological Review. Crit Care Med. 2015;43(11):2452–2459. - PMC - PubMed
    1. Halpern NA, Pastores SM. Critical care medicine in the United States 2000–2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Crit Care Med. 2010. Jan;38(1):65–71. - PubMed
    1. Angus DC, Kelley MA, Schmitz RJ, et al. , for the Committee on Manpower for Pulmonary and Critical Care Societies (COMPACCS). Current and Projected Workforce Requirements for Care of the Critically Ill and Patients With Pulmonary Disease: Can We Meet the Requirements of an Aging Population? JAMA. 2000;284(21):2762–2770. - PubMed
    1. Kahn Jeremy M. Understanding economic outcomes in critical care. Current Opinion in Critical Care 12(5):p 399–404, October 2006. - PubMed