Impact of critical care response team implementation on oncology patient outcomes: A retrospective cohort study

Introduction Advances in dialysis vascular access (DVA) management have changed where beneficiaries receive this care. The effectiveness, safety, quality, and economy of different care settings have been questioned. This study compares patient outcomes of receiving DVA services in the freestanding office-based center (FOC) to those of the hospital outpatient department (HOPD). It also examines whether outcomes differ for a centrally managed system of FOCs (CMFOC) compared to all other FOCs (AOFOC). Methods Retrospective cohort study of clinically and demographically similar patients within Medicare claims available through United States Renal Data System (USRDS) (2010-2013) who received at least 80% of DVA services in an FOC (n = 80,831) or HOPD (n = 133,965). Separately, FOC population is divided into CMFOC (n = 20,802) and AOFOC (n = 80,267). Propensity matching was used to control for clinical, demographic, and functional characteristics across populations. Results FOC patients experienced significantly better outcomes, including lower annual mortality (14.6% vs. 17.2%, p<0.001) and DVA-related infections (0.16 vs. 0.20, p<0.001), fewer hospitalizations (1.65 vs. 1.91, p<0.001), and lower total per-member-per-month (PMPM) payments ($5042 vs. $5361, p<0.001) than HOPD patients. CMFOC patients had lower annual mortality (12.5% vs. 13.8%, p<0.001), PMPM payments (DVA services) ($1486 vs. $1533, p<0.001) and hospitalizations ($1752 vs. $1816, p<0.001) than AOFOC patients. Conclusions Where nephrologists send patients for DVA services can impact patient clinical and economic outcomes. This research confirmed that patients who received DVA care in the FOC had better outcomes than those treated in the HOPD. The organizational culture and clinical oversight of the CMFOC may result in more favorable outcomes than receiving care in AOFOC.

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Hospital rapid response team and patients with life-limiting illness: A multicentre retrospective cohort study

Palliative Medicine ◽

10.1177/0269216314560802 ◽

2015 ◽

Vol 29 (4) ◽

pp. 302-309 ◽

Cited By ~ 29

Author(s):

Merlina Sulistio ◽

Michael Franco ◽

Amanda Vo ◽

Peter Poon ◽

Leeroy William

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Rapid Response Team ◽

Rapid Response ◽

Residential Aged Care ◽

Sample Population ◽

Goals Of Care ◽

Hospital Rapid Response Team ◽

Response Team

Background: Approximately one-third of rapid response team consultations involve issues of end-of-life care. We postulate a greater occurrence in patients with a life-limiting illness, in whom the opportunity for advance care planning and palliative care involvement should be offered. Aims: We aim to review the characteristics and compare outcomes of rapid response team consultations on patients with and without a life-limiting illness. Design/Setting: A 3-month retrospective cohort study of all rapid response team consultations was conducted. The sample population included all adult inpatients in a major teaching hospital network. Results: We identified 351 patients – including 139 with a life-limiting illness – receiving a total of 456 rapid response team consultations. The median time from admission to the first rapid response team consultation was 3 days. Patients with a life-limiting illness had a significantly higher mortality rate (41.7% vs 13.2%), were older (72.6 vs 63.5 years), more likely to come from a residential aged-care facility (29.5% vs 4.1%) and had a shorter hospital stay (10 vs 13 days). Rapid response team consultations resulted in a change to more palliative goals of care in 28.5% of patients, of whom two-thirds had a life-limiting illness. Conclusion: Patients with a life-limiting illness had worse outcomes post–rapid response team consultation. Our findings suggest that a routine clarification of goals of care for this cohort, within 3 days of hospital admission, may be advantageous. These discussions may provide clarity of purpose to treating teams, reduce the burden of unnecessary interventions and promote patient-centred care agreed upon in advance of any deterioration.

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Weighted-incidence syndromic combination antibiograms to guide empiric treatment of critical care infections: a retrospective cohort study

Critical Care ◽

10.1186/cc13901 ◽

2014 ◽

Vol 18 (3) ◽

pp. R112 ◽

Cited By ~ 15

Author(s):

Varinder Randhawa ◽

Syed Sarwar ◽

Sandra Walker ◽

Marion Elligsen ◽

Lesley Palmay ◽

...

Keyword(s):

Critical Care ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Empiric Treatment

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Inflammation Cytokine Expression and Association With Clinical Outcomes in Critically Ill Patients After Major Surgery: A Retrospective Cohort Study

10.21203/rs.3.rs-32628/v1 ◽

2020 ◽

Author(s):

Yamin Yan ◽

Xiaorong Wang ◽

Yan Hu ◽

Zhenghong Yu ◽

Yingjia Tang ◽

...

Keyword(s):

Cohort Study ◽

Mortality Rate ◽

Critically Ill ◽

Patient Outcomes ◽

Retrospective Cohort Study ◽

Critically Ill Patients ◽

Retrospective Cohort ◽

Major Surgery ◽

Increased Risk ◽

Tnf Α

Abstract Background The associations of serum cytokine levels and critically ill patient outcomes after major surgery remain unclear. The use of cytokine markers to predict outcomes in critically ill patients is controversial.Objective To determine the levels of IL-1β, IL-2, IL-6, IL-8, IL-10, TNF-α and procalcitonin in critical surgical ICU(SICU) patients and evaluate their associations with patient outcome and clinical significance.Methods This was a retrospective cohort study of consecutive patients admitted to the SICU in Zhongshan Hospital, Fudan University. The program ran from January 1, 2018, to June 30, 2019. The levels of IL-1β, IL-2, IL-6, IL-8, IL-10, TNF-α and procalcitonin were detected, and their relationship with patient outcomes was investigated.The primary outcome was in-hospital mortality, compared by a multivariable logistic regression analysis among the survivors and nonsurvivors.Results Overall, 5,257 patients were included in this study for their first SICU admission; 5,099 patients survived, 158 patients died, and the mortality rate was 3.0%(158/5,257). Univariate and multivariate analyses showed that nonsurvivors had increased levels of IL-1(OR=1.855, P=0.000) and IL-2(OR=1.51, P=0.000) compared with survivors. In addition, 196 patients(3.7%) were readmitted to the SICU, and data from 187 patients were collected. Of these, 161 patients survived, and 26 patients died; the mortality rate was 13.9%(26/187), which was much higher than that of the first round of patients. The level of IL-2 significantly influenced SICU readmission(OR=3.921, P=0.000).For the third round of SICU admission, 10 patients were included, 7 patients survived, and 3 patients died; the mortality rate was 30.0%(3/10). Furthermore, older age, longer time of SICU stay, and higher rate of mechanical ventilation and CRRT were associated with patient death.Conclusions High levels of cytokines may be risk factors for mortality and SICU readmission in critically ill patients who receive major surgery. Further work is still needed to determine which unmeasured characteristics and therapies may contribute to the increased risk observed.

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