Some ICU Admissions May Be Preventable, Saving Money and Improving Care

Research findings detailed in an “Potentially Preventable Intensive Care Unit Admissions in the United States, 2006-2015,” published in the Annals of the American Thoracic Society, indicate that many admissions to the intensive care unit (ICU) may be preventable, potentially decreasing health care costs and improving care.

Lead author Gary E. Weissman, MD, MSHP, a researcher at the Palliative and Advanced Illness Research Center at the University of Pennsylvania (UoP) in Philadelphia, and co-authors analyzed more than 16 million ICU admissions and estimated that between one in six and one in seven such admissions might have been avoided.

Critical Care Unit Photo Credit: U.S. National Library of Medicines

The UoP researchers analyzed three large data sources from 2006-15: Medicare Fee-for-Service, a Medicare Advantage plan and a large private national insurer. Altogether, the data sources represented nearly two-thirds of U.S. adults age 65 and older and about 13 percent of the entire U.S. population. During this time period, there were nearly 100 million hospital admissions, of which 16.7 percent included an ICU admission.

“This study was motivated by my experiences caring for patients in the medical ICU who required maximal life support because, a few weeks or months before, they couldn’t afford basic preventive medical services,” said Weissman.

There’s No “Gold Standard”

The study’s authors acknowledge in the published article that there is no “gold standard” definition of a preventable ICU admission. For their analysis, they identified two patient groups whose care could potentially be handled better outside the ICU: those with an “ambulatory care sensitive condition” and those with a “life-limiting malignancy” who are nearing the end of their life.

Patients in the first group have a chronic or medical condition such as high blood pressure, urinary tract infection or uncontrolled diabetes that with timely outpatient care can prevent the patient from being hospitalized.

Those in the second group are patients with cancer who are likely to die within a year and for whom palliative care may be appropriate. Although the authors only looked at life-limiting malignancy, they noted that ICU admissions may be preventable for other serious illnesses, including chronic lung disease, heart failure and neurodegenerative disorders.

According to the UoP study’s findings, over the 10-year time period, ICU hospitalizations for ambulatory care sensitive conditions have been slowly decreasing while the proportion of those in the ICU with a life-limiting malignancy has been increasing.  The researchers also found that there was a wide regional differences in ICU admissions and an almost eight-fold difference among states in the rates of ICU admissions.  Finally, the rate of ICU admissions in different geographic areas among these two patient groups appears to be explained partly by the number of ICU beds available.