Provision of critical care for the elderly in Europe : a retrospective comparison of national healthcare frameworks in intensive care units
Wernly, Bernhard (Paracelsus Medical University Salzburg)
Beil, Michael (Hadassah University Medical Center)
Bruno, Raphael Romano (University Hospital of Düsseldorf (Alemanya))
Binnebössel, Stephan (University Hospital of Düsseldorf (Alemanya))
Kelm, Malte (University Hospital of Düsseldorf (Alemanya))
Sigal, Sviri (Hadassah University Medical Center)
van Heerden, Peter Vernon (Hadassah Medical Center)
Boumendil, Ariane (Hôpital Saint-Antoine)
Artigas Raventós, Antoni (Universitat Autònoma de Barcelona. Departament de Medicina)
Cecconi, Maurizio (Humanitas University)
Marsh, Brian (Mater Misericordiae University Hospital(Dublín, Irlanda))
Moreno, Rui (Centro Hospitalar de Lisboa Central)
Oeyen, Sandra (University of Ghent)
Bollen Pinto, Bernardo (Geneva University Hospitals (Suïssa))
Szczeklik, Wojciech (Jagiellonian University Medical College)
Leaver, Susannah (Research Lead Critical Care Directorate St George's Hospital)
Walther, Sten Mikael (University Hospital)
Schefold, Joerg C. (Bern University Hospital)
Joannidis, Michael (Medizinische Universitat Innsbruck)
Fjølner, Jesper (Aarhus Universitet)
Zafeiridis, Tilemachos (General University Hospital of Larissa (Grècia))
De Lange, Dylan W.. (Utrecht University)
Guidet, Bertrand (Service de Réanimation Médicale Hôpital Saint-Antoine)
Flaatten, Hans (Haukeland University Hospital (Bergen, Noruega))
Jung, Christian (University Hospital of Düsseldorf (Alemanya))

Data:	2021
Resum:	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. ICUs in 16 European countries. In total, 7817 critically ill older (≥80 years) patients were included in this study, 4941 in THS and 2876 in the SHI systems. 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. 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. 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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Adult intensive & critical care ; Geriatric medicine ; Public health
Publicat a:	BMJ open, Vol. 11 (june 2021) , ISSN 2044-6055

DOI: 10.1136/bmjopen-2020-046909
PMID: 34083342

10 p, 771.5 KB

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