The purpose of this revised proposal is to examine posthospital outcomes for patients who require long-term mechanical ventilation while in hospital. Long-term ventilator (LTV) patients are those whose did not require mechanical ventilation prior to this hospitalization but whose response to acute illness includes major system failure resulting in prolonged in-hospital mechanical ventilation (5 days)(Daly et al., 1991; Douglas et al., 1995; Elpern, 1991). Although only 3% of all ICU admissions require long-term ICU care, LTV patients use 25%-30% of ICU days (Goins, 1991). The number of LTV patients continue to grow as we become more successful at getting patients through their acute phase of illness but leave them with significant care needs for prolonged periods. These patients are costly in human as well as financial terms. While some data describe the in-hospital experiences and outcomes of these patients, no studies have examined posthospital outcomes, caregiver experience, or resource use. Findings from this study can be used to assist patients and nurses in making informed decisions regarding initiation and continuation of technologic support as well as assist in posthospital planning for resource use. The specific research aims are to describe: (1) sociodemographic and clinical characteristics of LTV patients, (2) posthospital outcomes (mortality, quality of life, functional status) for LTV patients, (3) posthospital experience (strain, coping, depression) for caregivers of LTV patients, and (4) formal and informal resources used by LTV patients following hospital discharge.
These aims will be accomplished by a longitudinal descriptive study of patients who meet the criteria of requiring 5 days of mechanical ventilation while in hospital. Data will be obtained via interview within 1 week of hospital discharge, and at 6 and 12 months post-hospital discharge. Resource use will be documented (patient resource use diary) to assess the quantity and type of services used posthospital. Standardized charges will be assigned to services utilized by patients. Modern methods in statistical graphics, smoothing, and generalized modeling will be used to provide an in-depth profile of LTV patients' posthospital outcomes and resource use, and caregivers' experiences. To contrast the experience of this group of patients and caregivers, we will also enroll patients who have required 1-4 days of in-hospital mechanical ventilation.
| Douglas, Sara L; Daly, Barbara J; O'Toole, Elizabeth E et al. (2009) Age differences in survival outcomes and resource use for chronically critically ill patients. J Crit Care 24:302-10 |
| Kelley, Carol G; Lipson, Amy R; Daly, Barbara J et al. (2006) Use of advance directives in the chronically critically ill. JONAS Healthc Law Ethics Regul 8:42-7; quiz 48-9 |
| Douglas, Sara L; Daly, Barbara J (2003) Caregivers of long-term ventilator patients: physical and psychological outcomes. Chest 123:1073-81 |
| Douglas, Sara L; Daly, Barbara J; Gordon, Nahida et al. (2002) Survival and quality of life: short-term versus long-term ventilator patients. Crit Care Med 30:2655-62 |
| Douglas, S L; Daly, B J; Brennan, P F et al. (2001) Hospital readmission among long-term ventilator patients. Chest 120:1278-86 |
