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J Crit Care. 2019 Feb 26;51:175-183. doi: 10.1016/j.jcrc.2019.02.025. [Epub ahead of print]

Association between strained ICU capacity and healthcare costs in Canada: A population-based cohort study.

Author information

1
Institute of Health Economics, Edmonton, Alberta, Canada.
2
Institute of Health Economics, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
3
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada.
4
Research Facilitation, Analytics (DIMR), Alberta Health Services, Edmonton, Canada.
5
Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada; Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
6
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
7
Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada; Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
8
School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada. Electronic address: bagshaw@ualberta.ca.

Abstract

BACKGROUND:

Intensive care is resource intensive, with costs representing a substantial quantity of total hospitalization costs. Strained ICU capacity compromises care quality and adversely impacts outcomes; however, the association between strain and healthcare costs has not been explored.

MATERIALS AND METHODS:

Population-based cohort study performed in 17 adult ICUs in Alberta, Canada. Data were captured on hospitalizations, ambulatory care, physician services and drug dispenses occurring 1-year before and 1-year after index ICU admission. Strain was defined as occupancy ≥90%; with 21 additional definitions evaluated. Patients were categorized as strain and non-strain admissions. Costs attributable to strain, were calculated as difference-in-difference costs using propensity-score matching.

RESULTS:

30,557 patients were included (strain: 11,830 [38.7%]; non-strain: 18,727 [61.3%]). At 1-year, strain admissions had adjusted-incremental per-patient cost of CA$9406 (95%CI, $5654-13,157) compared to non-strain admissions, due to hospitalization costs (CA$7930; 95%CI, $4553-11,307) and physician claims (CA$844; 95%CI, $430-1259). This equated to CA$111.3 million (95%CI, $66.9-155.6 million) in excess attributable costs. Strain portended longer hospitalization (3.3 days; 95%CI, 1.1-5.5); and more ambulatory visits (1.0; 95%CI, 0.1-2.0) and physician claims (9.5; 95%CI, 6.2-12.7). Incremental costs were robust across strain definitions.

CONCLUSIONS:

Admissions to ICUs experiencing strain incur incremental costs, attributed to longer hospitalization and physician services.

KEYWORDS:

Costs; Critical care; Health economics; Organization; Outcome; Utilization

PMID:
30852346
DOI:
10.1016/j.jcrc.2019.02.025

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