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Prior healthcare utilization as a predictor of survival for medical intensive care unit patients
A A Quartin1, R M Schein, D H Kett
1Department of Medicine, University of Miami School of Medicine and the Miami Veterans Affairs Medical Center, FL, USA.
Objective:
To determine whether measures of inpatient care utilization from the year preceding admission to a medical intensive care unit (MICU) improve physiology-based predictions of hospital and 1-yr survival.
Design:
Inception cohort study with a validation cohort.
Setting:
The MICU in university-affiliated Department of Veterans Affairs Medical Center.
Patients:
A total of 1,200 consecutive patients admitted to the MICU.
Measurements And Main Results:
Increased use of inpatient health care before MICU admission was associated with increased mortality. However, inpatient utilization data failed to improve physiology-based logistic models for hospital and 1-yr survival (p > .15 for improvement in the area under the receiver operating characteristic curve for both end points in the validation cohort), whereas physiologic data improved models derived from measures of inpatient care (p < .001 for both end points). Empirically derived inpatient care models used only information from the few days preceding MICU admission, despite the availability of a full year of data.
Conclusions:
Chronic illness, as gauged by a need for frequent inpatient care in the year before MICU admission, is not independently predictive of poor short- or long-term survival. Clinicians should not attempt to predict survival of prospective MICU patients by the extent of previous inpatient care.