背景:本研究旨在确定烧伤和外科重症监护病房(ICU)患者的健康和普遍合并症的社会决定因素对多个指标的护理质量的重要性。
方法:我们对2016年1月1日至2019年11月18日在烧伤和外科ICU住院的患者的人群数据进行了回顾性分析。主要结果是住院时间(LOS),死亡率,重新接纳30天,和医院费用。分类变量的Pearson卡方检验和连续变量的t检验用于比较人群健康组。
结果:我们共分析了487例烧伤患者和510例手术患者。当比较ICU患者时,我们观察到有精神健康史的BICU诉SICU患者的平均住院费用和住院时间(LOS)明显更高($93,259.40v$50,503.36,p=0.013和16.28v.9.16天,p=0.0085),终末期肾病(ESRD)($653,871.05v$75,746.35,p=0.0047和96.15v.17.53天,p=0.0104),败血症(267,979.60美元v$99,154.41,p=<0.001和39.1v18.42天,p=0.0043),和静脉血栓栓塞(VTE)($757,740.50v$117,816.40,p=<0.001和93.11v.20.21天,p=0.002)。此外,有ESRD的烧伤患者死亡率较高,ST段抬高型心肌梗死(STEMI),脓毒症,VTE,和糖尿病。在有精神健康史的烧伤患者中,30天的再入院率更高,药物依赖,心力衰竭,和糖尿病。
结论:我们的研究为在不同重症监护环境中接受治疗的烧伤患者之间的预后差异提供了新的见解。强调合并症对这些结果的影响。通过将BICU中的烧伤患者与SICU中的烧伤患者进行比较,我们的目标是强调患者背景的差异,包括所接受护理的质量,为这些结果做出贡献。这种比较强调了需要考虑每个患者群体面临的独特挑战的量身定制的医疗保健策略。旨在减轻健康结果和医疗保健支出方面的差距。进一步研究制定相关和及时的干预措施,以改善这些结果。
This study aims to establish the significance of social determinants of health and prevalent co-morbidities on multiple indicators for quality of care in patients admitted to the Burn and Surgical Intensive Care Unit (ICU).
We performed a retrospective analysis of population group data for patients admitted at the Burn and Surgical ICU from January 1, 2016, to November 18, 2019. The primary outcomes were length of hospital stay (LOS), mortality, 30-day readmission, and hospital charges. Pearson\'s chi-square test for categorical variables and t-test for continuous variables were used to compare population health groups.
We analyzed a total of 487 burn and 510 surgical patients. When comparing ICU patients, we observed significantly higher mean hospital charges and length of stay (LOS) in BICU v. SICU patients with a history of mental health ($93,259.40 v. $50,503.36, p = 0.013 and 16.28 v. 9.16 days, p = 0.0085), end-stage-renal-disease (ESRD) ($653,871.05 v. $75,746.35, p = 0.0047 and 96.15 v. 17.53 days, p = 0.0104), sepsis ($267,979.60 v. $99,154.41, p = <0.001 and 39.1 v. 18.42 days, p = 0.0043), and venous thromboembolism (VTE) ($757,740.50 v. $117,816.40, p = <0.001 and 93.11 v. 20.21 days, p = 0.002). Also, higher mortality was observed in burn patients with ESRD, ST-Elevation Myocardial Infarction (STEMI), sepsis, VTE, and diabetes mellitus. 30-day-readmissions were greater among burn patients with a history of mental health, drug dependence, heart failure, and diabetes mellitus.
Our study provides new insights into the variability of outcomes between burn patients treated in different critical care settings, underlining the influence of comorbidities on these outcomes. By comparing burn patients in the BICU with those in the SICU, we aim to highlight how differences in patient backgrounds, including the quality of care received, contribute to these outcomes. This comparison underscores the need for tailored healthcare strategies that consider the unique challenges faced by each patient group, aiming to mitigate disparities in health outcomes and healthcare spending. Further research to develop relevant and timely interventions that can improve these outcomes.