Population Trends in Intensive Care Unit Admissions in the United States Among Medicare Beneficiaries, 2006–2015

Letters5 February 2019Population Trends in Intensive Care Unit Admissions in the United States Among Medicare Beneficiaries, 2006–2015Correction(s) for this article:CorrectionsMay 2019Correction: Error in Letters in 5 February 2019FREEGary E. Weissman, MD, MSHP, Meeta Prasad Kerlin, MD, MSCE, Yihao Yuan, MS, Nicole B. Gabler, PhD, MPH, Peter W. Groeneveld, MD, MS, Rachel M. Werner, MD, PhD, and Scott D. Halpern, MD, PhDGary E. Weissman, MD, MSHPPalliative and Advanced Illness Research Center, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.P.K., S.D.H.), Meeta Prasad Kerlin, MD, MSCEPalliative and Advanced Illness Research Center, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.P.K., S.D.H.), Yihao Yuan, MSPerelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Y.Y., N.B.G.), Nicole B. Gabler, PhD, MPHPerelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Y.Y., N.B.G.), Peter W. Groeneveld, MD, MSLeonard Davis Institute of Health Economics and Perelman School of Medicine, University of Pennsylvania, and Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania (P.W.G., R.M.W.), Rachel M. Werner, MD, PhDLeonard Davis Institute of Health Economics and Perelman School of Medicine, University of Pennsylvania, and Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania (P.W.G., R.M.W.), and Scott D. Halpern, MD, PhDPalliative and Advanced Illness Research Center, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.P.K., S.D.H.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-1425 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Admission to the intensive care unit (ICU) is costly and strains health system resources (1). Accurate estimates of population-level ICU admission rates could aid in disaster planning, training a suitable critical care workforce, and targeting policy interventions to reduce admissions that are low-value or discordant with patient preferences.Objective: To overcome limitations of prior estimates of ICU use (2) by evaluating nationally representative data and examining geographic differences in admission incidence.Methods and Findings: Using the entire Medicare Provider Analysis and Review file, we evaluated all hospitalizations involving acute and ICU care (including cardiac intensive care but not intermediate ...References1. Halpern SD. ICU capacity strain and the quality and allocation of critical care. Curr Opin Crit Care. 2011;17:648-57. PMID: 21986461 doi:10.1097/MCC.0b013e32834c7a53 CrossrefMedlineGoogle Scholar2. Wunsch H, Angus DC, Harrison DA, Collange O, Fowler R, Hoste EA, et al. Variation in critical care services across North America and Western Europe. Crit Care Med. 2008;36:2787-93. PMID: 18766102 doi:10.1097/CCM.0b013e318186aec8 CrossrefMedlineGoogle Scholar3. Weissman GE, Hubbard RA, Kohn R, Anesi GL, Manaker S, Kerlin MP, et al. Validation of an administrative definition of ICU admission using revenue center codes. Crit Care Med. 2017;45:e758-62. PMID: 28441234 doi:10.1097/CCM.0000000000002374 CrossrefMedlineGoogle Scholar4. Wallace DJ, Angus DC, Seymour CW, Barnato AE, Kahn JM. Critical care bed growth in the United States. A comparison of regional and national trends. Am J Respir Crit Care Med. 2015;191:410-6. PMID: 25522054 doi:10.1164/rccm.201409-1746OC CrossrefMedlineGoogle Scholar5. Wallace DJ, Seymour CW, Kahn JM. Hospital-level changes in adult ICU bed supply in the United States. Crit Care Med. 2017;45:e67-76. PMID: 27661861 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Palliative and Advanced Illness Research Center, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.P.K., S.D.H.)Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Y.Y., N.B.G.)Leonard Davis Institute of Health Economics and Perelman School of Medicine, University of Pennsylvania, and Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania (P.W.G., R.M.W.)Disclaimer: The funding sources had no role in the study.Acknowledgment: The authors thank George L. Anesi, MD, MSCE, MBE, and Rachel Kohn, MD, MSCE, from the Palliative and Advanced Illness Research Center and Pulmonary and Critical Care Division at the University of Pennsylvania for their comments in developing this study.Grant Support: By National Institutes of Health/National Heart, Lung, and Blood Institute grants T32-HL098054 and K23-HL141639 (Dr. Weissman) and in part by National Institutes of Health/National Institute on Aging grant K24-AG047908 (Dr. Werner and Ms. Yuan).Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1425.Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Dr. Weissman (e-mail, gary.email protectedupenn.edu).This article was published at Annals.org on 16 October 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCorrection: Error in Letters in 5 February 2019 Metrics Cited byHospital Capacity Strain as a Window into the Value of ICU Admission: Some Answers, More QuestionsRecent Trends in Admission Diagnosis and Related Mortality in the Medically Critically IllCourse and predictors of posttraumatic stress-related symptoms among family members of deceased ICU patients during the first year of bereavementFunctional Effects of Intervening Illnesses and Injuries After Critical Illness in Older PersonsEpidemiology and outcomes of invasive mechanical ventilation without ICU admission in acute care hospitals in Texas: A population-based cohort studySurveillance Strategies for Tracking Sepsis Incidence and OutcomesDemographic Shifts, Case Mix, Activity, and Outcome for Elderly Patients Admitted to Adult General ICUs in England, Wales, and Northern IrelandSelecting the Best Instrument to Measure Family Perceptions of End-of-Life Communication in Intensive Care UnitsPotentially Preventable Intensive Care Unit Admissions in the United States, 2006–2015Correction: Error in Letters in 5 February 2019 5 February 2019Volume 170, Issue 3Page: 213-215KeywordsCritical careDatabasesDisclosureHeartHospitalizationsInstitutional review boardsIntensive care unitsLungsMedicarePublic policy ePublished: 16 October 2018 Issue Published: 5 February 2019 Copyright & PermissionsCopyright © 2018 by American College of Physicians. 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