AI Article Synopsis

  • Increasing the number of ICU beds and critical care staff is common advice for dealing with an aging, complex population, but reducing preventable ICU stays could be a viable alternative.
  • Analysis of Medicare and private insurance data revealed that a significant portion of ICU admissions (around 16.7%) were linked to potentially preventable conditions, with about 12-16% associated with ambulatory care sensitive conditions (ACSCs).
  • Over a decade, ACSC-related ICU stays showed a decline across different insurance types, suggesting that strengthening outpatient care could help prevent unnecessary ICU admissions, highlighting the need for investment in community health infrastructure instead of just expanding ICU capacity.

Article Abstract

Increasing intensive care unit (ICU) beds and the critical care workforce are often advocated to address an aging and increasingly medically complex population. However, reducing potentially preventable ICU stays may be an alternative to ensure adequate capacity. To determine the proportions of ICU admissions meeting two definitions of being potentially preventable using nationally representative U.S. claims databases. We analyzed claims from 2006 to 2015 from all Medicare Fee-for-Service (FFS) beneficiaries and from a large national payer offering a private insurance (PI) plan and a Medicare Advantage (MA) plan. Potentially preventable hospitalizations were identified using existing definitions for ambulatory care sensitive conditions (ACSCs) and life-limiting malignancies (LLMs). We analyzed 420,369,434 person-years of insurance coverage, during which there were 99,793,416 acute inpatient hospitalizations, of which 16,646,977 (16.7%) were associated with an ICU admission. Of these, the proportions with an ACSC were 12.9%, 12.7%, and 15.8%, and with an LLM were 5.2%, 5.4%, and 6.4%, among those with PI, MA, and FFS, respectively. Over 10 years, the absolute percentages of ACSC-associated ICU stays declined (PI = -1.1%, MA -6.4%, FFS -6.4%; all  < 0.001 for all trends). Smaller changes were noted among LLM-associated ICU stays, declining in the MA cohort (-0.8%) and increasing in the FFS (+0.3%) and PI (+0.2%) populations ( < 0.001 for all trends). An appreciable proportion of U.S. ICU admissions may be preventable with community-based interventions. Investment in the outpatient infrastructure required to prevent these ICU admissions should be considered as a complementary, if not alternative, strategy to expanding ICU capacity to meet future demand.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6944341PMC
http://dx.doi.org/10.1513/AnnalsATS.201905-366OCDOI Listing

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