Association between unmet medication needs after hospital discharge and readmission or death among acute respiratory failure survivors: the addressing post-intensive care syndrome (APICS-01) multicenter prospective cohort study

Samuel M Brown; Victor D Dinglas; Narjes Akhlaghi; Somnath Bose; Valerie Banner-Goodspeed; Sarah Beesley; Danielle Groat; Tom Greene; Ramona O Hopkins; Mustafa Mir-Kasimov; Carla M Sevin; Alison E Turnbull; James C Jackson; Dale M Needham; APICS-01 Study Team

doi:10.1186/s13054-021-03848-3

Association between unmet medication needs after hospital discharge and readmission or death among acute respiratory failure survivors: the addressing post-intensive care syndrome (APICS-01) multicenter prospective cohort study

Crit Care. 2022 Jan 7;26(1):6. doi: 10.1186/s13054-021-03848-3.

Authors

Samuel M Brown^{1

2

3

4}, Victor D Dinglas⁵, Narjes Akhlaghi⁶, Somnath Bose⁷, Valerie Banner-Goodspeed⁷, Sarah Beesley^{8

9

10}, Danielle Groat^{8

10}, Tom Greene¹¹, Ramona O Hopkins^{10

12}, Mustafa Mir-Kasimov^{9

13}, Carla M Sevin¹⁴, Alison E Turnbull⁵, James C Jackson¹⁴, Dale M Needham⁵; APICS-01 Study Team

Collaborators

APICS-01 Study Team:
Elise Caraker, Sai Phani Sree Cherukuri, Naga Preethi Kadiri, Tejaswi Kalva, Mounica Koneru, Pooja Kota, Emma Maelian Lee, Mazin Ali Mahmoud, Albahi Malik, Roozbeh Nikooie, Darin Roberts, Sriharsha Singu, Parvaneh Vaziri, Katie Brown, Austin Daw, Mardee Merrill, Rilee Smith, Ellie Hirshberg, Jorie Butler, Benjamin Hoenig, Maria Karamourtopoulos, Margaret Hays, Rebecca Abel, Craig High, Emily Beck, Brent Armbruster, Darrin Applegate, Melissa Fergus, Naresh Kumar, Megan Roth, Susan Mogan, Rebecca Abel, Andrea De Souza Licht, Isabel Londono, Julia Larson, Krystal Capers, Maria Karamourtopoulos, Benjamin Hoenig, Andrew Toksoz-Exley, Julia Crane

Affiliations

¹ Pulmonary and Critical Care Medicine, Intermountain Medical Center, Salt Lake City, UT, USA. Samuel.Brown@imail.org.
² Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT, USA. Samuel.Brown@imail.org.
³ Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, UT, USA. Samuel.Brown@imail.org.
⁴ Shock Trauma ICU, Intermountain Medical Center, 5121 S. Cottonwood Street, Murray, UT, 84107, USA. Samuel.Brown@imail.org.
⁵ Outcomes After Critical Illness and Surgery (OACIS) Group and Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁶ Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
⁷ Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁸ Pulmonary and Critical Care Medicine, Intermountain Medical Center, Salt Lake City, UT, USA.
⁹ Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT, USA.
¹⁰ Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, UT, USA.
¹¹ Biostatistics and Epidemiology, University of Utah, Salt Lake City, UT, USA.
¹² Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT, USA.
¹³ Salt Lake City Veterans Administration, Salt Lake City, UT, USA.
¹⁴ Vanderbilt University Medical Center, Nashville, TN, USA.

Abstract

Introduction: Survivors of acute respiratory failure (ARF) commonly experience long-lasting physical, cognitive, and/or mental health impairments. Unmet medication needs occurring immediately after hospital discharge may have an important effect on subsequent recovery.

Methods and analysis: In this multicenter prospective cohort study, we enrolled ARF survivors who were discharged directly home from their acute care hospitalization. The primary exposure was unmet medication needs. The primary outcome was hospital readmission or death within 3 months after discharge. We performed a propensity score analysis, using inverse probability weighting for the primary exposure, to evaluate the exposure-outcome association, with an a priori sample size of 200 ARF survivors.

Results: We enrolled 200 ARF survivors, of whom 107 (53%) were female and 77 (39%) were people of color. Median (IQR) age was 55 (43-66) years, APACHE II score 20 (15-26) points, and hospital length of stay 14 (9-21) days. Of the 200 participants, 195 (98%) were in the analytic cohort. One hundred fourteen (57%) patients had at least one unmet medication need; the proportion of medication needs that were unmet was 6% (0-15%). Fifty-six (29%) patients were readmitted or died by 3 months; 10 (5%) died within 3 months. Unmet needs were not associated (risk ratio 1.25; 95% CI 0.75-2.1) with hospital readmission or death, although a higher proportion of unmet needs may have been associated with increased hospital readmission (risk ratio 1.7; 95% CI 0.96-3.1) and decreased mortality (risk ratio 0.13; 95% CI 0.02-0.99).

Discussion: Unmet medication needs are common among survivors of acute respiratory failure shortly after discharge home. The association of unmet medication needs with 3-month readmission and mortality is complex and requires additional investigation to inform clinical trials of interventions to reduce unmet medication needs. Study registration number: NCT03738774 . The study was prospectively registered before enrollment of the first patient.

Keywords: Acute respiratory failure; Discharge planning; Health services research; Long-term outcomes.

Publication types

Multicenter Study
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Aged
Cohort Studies
Critical Illness
Female
Hospitals
Humans
Middle Aged
Patient Discharge*
Patient Readmission
Prospective Studies
Respiratory Insufficiency*
Survivors

Supplementary concepts

postintensive care syndrome

Grants and funding

W81XWH-17-PRMRP-IIRA/U.S. Department of Defense