Use of Life Support and Outcomes Among Patients Admitted to Intensive Care Units
JAMA,
Journal Year:
2025,
Volume and Issue:
unknown
Published: April 14, 2025
Importance
Nationwide
data
are
unavailable
regarding
changes
in
intensive
care
unit
(ICU)
outcomes
and
use
of
life
support
over
the
past
10
years,
limiting
understanding
practice
changes.
Objective
To
portray
epidemiology
US
critical
before,
during,
after
COVID-19
pandemic.
Design,
Setting,
Participants
Retrospective
cohort
study
adult
patients
admitted
to
an
ICU
for
any
reason,
using
from
54
health
systems
continuously
contributing
Epic
Cosmos
database
2014-2023.
Exposures
Patient
demographics,
status,
pandemic
era.
Main
Outcomes
Measures
In-hospital
mortality
unadjusted
adjusted
patient
comorbidities,
illness
severity;
length
stay;
receipt
life-support
interventions,
including
mechanical
ventilation
vasopressor
medications.
Results
Of
3
453
687
admissions
care,
median
age
was
65
(IQR,
53-75)
years.
Patients
were
55.3%
male;
17.3%
Black
6.1%
Hispanic
or
Latino;
overall
in-hospital
10.9%.
The
elevated
during
COVID-negative
(adjusted
odds
ratio
[aOR],
1.3
[95%
CI,
1.2-1.3])
COVID-positive
(aOR,
4.3
3.8-4.8])
returned
baseline
by
mid-2022.
stay
2.1
1.1-4.2)
days,
with
increases
among
(difference
vs
patients,
2.0
days
2.0-2.1]).
Rates
invasive
23.2%
(95%
23.1%-23.2%)
before
pandemic,
increased
25.8%
25.8%-25.9%)
declined
below
prepandemic
thereafter
(22.0%
21.9%-22.2%]).
vasopressors
7.2%
21.6%
stays.
Conclusions
Relevance
Pandemic-era
recent
historical
baselines.
Fewer
now
receiving
than
prior
while
more
administered
Language: Английский
Evaluation of an outreach programme for patients with COVID-19 in an integrated healthcare delivery system: a retrospective cohort study
BMJ Open,
Journal Year:
2024,
Volume and Issue:
14(1), P. e073622 - e073622
Published: Jan. 1, 2024
Objectives
In
the
first
year
of
COVID-19
pandemic,
health
systems
implemented
programmes
to
manage
outpatients
with
COVID-19.
The
goal
was
expedite
patients’
referral
acute
care
and
prevent
overcrowding
medical
centres.
We
sought
evaluate
impact
such
a
programme,
Home
Care
Team
(CHCT)
programme.
Design
Retrospective
cohort.
Setting
Kaiser
Permanente
Northern
California.
Participants
Adult
members
before
vaccine
availability
(1
February
2020–31
January
2021)
positive
SARS-CoV-2
tests.
Intervention
Virtual
programme
track
treat
patients
‘CHCT
programme’.
Outcomes
outcomes
were
(1)
COVID-19-related
emergency
department
visit,
(2)
hospitalisation
(3)
inpatient
mortality
or
30-day
hospice
referral.
Measures
estimated
average
effect
comparing
who
not
treated
by
CHCT.
propensity
scores
using
an
ensemble
super
learner
(random
forest,
XGBoost,
generalised
additive
model
multivariate
adaptive
regression
splines)
augmented
inverse
probability
weighting.
Results
There
98
585
majority
followed
CHCT
(n=80
067,
81.2%).
Patients
older
(mean
age
43.9
vs
41.6
years,
p<0.001)
more
comorbid
COmorbidity
Point
Score,
V.2,
score
≥65
(1.7%
1.1%,
p<0.001).
Unadjusted
analyses
showed
visits
(9.5%
8.5%,
hospitalisations
(3.9%
3.2%,
in
but
lower
death
(0.3%
0.5%,
After
weighting,
there
higher
rates
(estimated
intervention
−0.8%,
95%
CI
−1.4%
−0.3%)
(−0.5%,
−0.9%
−0.1%)
−0.7%
Conclusions
Despite
following
comorbidity
burden,
appeared
be
protective
effect.
likely
present
less
die
inpatient.
Language: Английский