Posted 7-19-01
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| Sara Douglas | Barbara Daly |
CLEVELAND -- Researchers at Case Western Reserve University are launching a three-year study of an intervention that is designed to reduce healthcare costs and improve outcomes of chronically critically ill patients who are discharged from hospitals.
This $1.6 million project, funded by the National Institute of Nursing Research of the National Institutes of Health, is the first to test an outpatient intervention targeting this small but costly patient population.
The chronically critically ill are typically older people who have required long periods of mechanical ventilation in intensive care units (ICU) either because of complications of surgery or worsening of chronic conditions, according to researchers at CWRU's Frances Payne Bolton School of Nursing.
Upon discharge, such patients require extensive ongoing care and are at high-risk for costly re-hospitalization.
Bolton School researchers will study 400 patients after they are discharged from University Hospitals of Cleveland to either an extended care facility or to their home with the assistance of visiting nurses or home health care services.
The patients will be randomly assigned to either a control group, which will get the usually prescribed post-discharge care, or to the experimental group, which will get the usual care plus an advanced practice nurse (APN) as case manager. Working in collaboration with a pulmonologist and gerontologist, the APNs will implement a disease-management program designed to streamline care, communication, and clinical decision-making.
Researchers will examine the impact of the two-month intervention on relative resource use, functional status, and clinical outcomes, including quality of life, mortality, and rehospitalizations. In addition, they will interview patients and caregivers to assess satisfaction with care.
The primary family caregiver of these patients typically experiences significant burdens, often accompanied by physical and emotional health problems, according to the Bolton School researchers, Barbara Daly, an associate professor, and Sara Douglas, a research associate professor. This study will also compare levels of caregiving burden, overload, and depression among family caregivers of the two groups.
The chronically critically ill have been recognized as a distinct patient group only for the past decade, and their numbers are growing as improved medical technology and treatment have enabled health care professionals to successfully intervene in life-threatening cases of acute illness.
While only 3 to 5 percent of ICU patients are considered chronically critically ill, they consume an estimated 25 to30 percent of ICU time and resources. "These patients present enormous challenges in care and are consistently reported to be among the highest in cost, accounting for nearly $18 billion in annual spending nationwide," Daly observes.
Previous studies by Daly and Douglas have demonstrated that a "Special Care Unit" designed specifically for the chronically critically ill can reduce inpatient costs and improve clinical outcomes.
"The current project is designed to extend those features of the Special Care Unit that were shown to be effective during hospitalization to the first two months of the post-discharge period," Douglas explains.
In addition to Daly and Douglas, the research team will include Hugo Montenegro and Elizabeth O'Toole, both physicians at UH, and Elizabeth Madigan, an associate professor and assistant dean for international health programs at the Bolton School.
