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Provision of critic...
Provision of critical care for the elderly in Europe : a retrospective comparison of national healthcare frameworks in intensive care units
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- Wernly, Bernhard (författare)
- Paracelsus Med Univ Salzburg, Austria
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- Beil, Michael (författare)
- Hadassah Univ, Israel
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- Bruno, Raphael Romano (författare)
- Univ Hosp Dusseldorf, Germany
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- Binnebössel, Stephan (författare)
- Univ Hosp Dusseldorf, Germany
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- Kelm, Malte (författare)
- Univ Hosp Dusseldorf, Germany
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- Sigal, Sviri (författare)
- Hadassah Univ, Israel
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- van Heerden, Peter Vernon (författare)
- Hadassah Med Ctr, Israel
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- Boumendil, Ariane (författare)
- Hop St Antoine, France
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- Artigas, Antonio (författare)
- Autonomous Univ Barcelona, Spain
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- Cecconi, Maurizio (författare)
- Humanitas Univ, Italy
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- Marsh, Brian (författare)
- Mater Misericordiae Univ Hosp, Ireland
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- Moreno, Rui (författare)
- Hosp Sao Jose, Portugal
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- Oeyen, Sandra (författare)
- Univ Ghent, Belgium
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- Bollen Pinto, Bernardo (författare)
- Geneva Univ Hosp, Switzerland
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- Szczeklik, Wojciech (författare)
- Jagiellonian Univ Med Coll, Poland
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- Leaver, Susannah (författare)
- St George Hosp, England
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- Walther, Sten (författare)
- Linköpings universitet,Medicinska fakulteten,Avdelningen för kardiovaskulär medicin,Region Östergötland, Thorax-kärlkliniken i Östergötland
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- Schefold, Joerg C (författare)
- Bern Univ Hosp, Switzerland
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- Joannidis, Michael (författare)
- Med Univ Innsbruck, Austria
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- Fjølner, Jesper (författare)
- Aarhus Univ, Denmark
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- Zafeiridis, Tilemachos (författare)
- Gen Univ Hosp Larissa, Greece
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- de Lange, Dylan (författare)
- Univ Utrecht, Netherlands
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- Guidet, Bertrand (författare)
- Hop St Antoine, France
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- Flaatten, Hans (författare)
- Haukeland Hosp, Norway
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- Jung, Christian (författare)
- Univ Hosp Dusseldorf, Germany
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- Brorsson, Camilla (bidragsgivare)
- Umeå universitet,Anestesiologi och intensivvård,VIP2 study group
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(creator_code:org_t)
- 2021-06-03
- 2021
- Engelska.
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Ingår i: BMJ Open. - London, United Kingdom : BMJ Publishing Group Ltd. - 2044-6055. ; 11:6
- Relaterad länk:
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https://doi.org/10.1...
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https://umu.diva-por... (primary) (Raw object)
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https://bmjopen.bmj....
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https://liu.diva-por... (primary) (Raw object)
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https://urn.kb.se/re...
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https://doi.org/10.1...
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https://urn.kb.se/re...
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Abstract
Ämnesord
Stäng
- OBJECTIVES: In Europe, there is a distinction between two different healthcare organisation systems, the tax-based healthcare system (THS) and the social health insurance system (SHI). Our aim was to investigate whether the characteristics, treatment and mortality of older, critically ill patients in the intensive care unit (ICU) differed between THS and SHI.SETTING: ICUs in 16 European countries.PARTICIPANTS: In total, 7817 critically ill older (≥80 years) patients were included in this study, 4941 in THS and 2876 in the SHI systems.PRIMARY AND SECONDARY OUTCOMES MEASURES: We chose generalised estimation equations with robust standard errors to produce population average adjusted OR (aOR). We adjusted for patient-specific variables, health economic data, including gross domestic product (GDP) and human development index (HDI), and treatment strategies.RESULTS: In SHI systems, there were higher rates of frail patients (Clinical Frailty Scale>4; 46% vs 41%; p<0.001), longer length of ICU stays (90±162 vs 72±134 hours; p<0.001) and increased levels of organ support. The ICU mortality (aOR 1.50, 95% CI 1.09 to 2.06; p=0.01) was consistently higher in the SHI; however, the 30-day mortality (aOR 0.89, 95% CI 0.66 to 1.21; p=0.47) was similar between THS and SHI. In a sensitivity analysis stratifying for the health economic data, the 30-day mortality was higher in SHI, in low GDP per capita (aOR 2.17, 95% CI 1.42 to 3.58) and low HDI (aOR 1.22, 95% CI 1.64 to 2.20) settings.CONCLUSIONS: The 30-day mortality was similar in both systems. Patients in SHI were older, sicker and frailer at baseline, which could be interpreted as a sign for a more liberal admission policy in SHI. We believe that the observed trend towards ICU excess mortality in SHI results mainly from a more liberal admission policy and an increase in treatment limitations.TRIAL REGISTRATION NUMBERS: NCT03134807 and NCT03370692.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Health Care Service and Management, Health Policy and Services and Health Economy (hsv//eng)
Nyckelord
- adult intensive & critical care
- geriatric medicine
- public health
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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Wernly, Bernhard
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Beil, Michael
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Bruno, Raphael R ...
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Binnebössel, Ste ...
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Kelm, Malte
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Sigal, Sviri
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van Heerden, Pet ...
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Boumendil, Arian ...
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Artigas, Antonio
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Cecconi, Maurizi ...
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Marsh, Brian
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Moreno, Rui
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Oeyen, Sandra
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Bollen Pinto, Be ...
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Szczeklik, Wojci ...
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Leaver, Susannah
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Walther, Sten
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Schefold, Joerg ...
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Joannidis, Micha ...
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Fjølner, Jesper
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Zafeiridis, Tile ...
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de Lange, Dylan
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Guidet, Bertrand
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Flaatten, Hans
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Jung, Christian
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Brorsson, Camill ...
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MEDICIN OCH HÄLS ...
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och Klinisk medicin
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och Anestesi och int ...
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