Gary Weissman, MD, MSHP Assistant Professor of Medicine Pulmonary, Allergy, and Critical Care Division Palliative and Advanced Illness Research (PAIR) Center University of Pennsylvania Perelman School of Medicine 

Primary and Palliative Care Can Prevent Significant Number of ICU Admissions

MedicalResearch.com Interview with:

Gary Weissman, MD, MSHP Assistant Professor of Medicine Pulmonary, Allergy, and Critical Care Division Palliative and Advanced Illness Research (PAIR) Center University of Pennsylvania Perelman School of Medicine 

Dr. Weissman

Gary Weissman, MD, MSHP
Assistant Professor of Medicine
Pulmonary, Allergy, and Critical Care Division
Palliative and Advanced Illness Research (PAIR) Center
University of Pennsylvania Perelman School of Medicine 

MedicalResearch.com: What is the background for this study?

Response: There are millions of hospitalizations every year in the United States (US) that include a stay in an intensive care unit (ICU). Such ICU stays put strain on health system resources, may be unwanted by patients, and are costly to society. As the population of the US gets older and more medically complex, some have argued that we need more ICU beds and a larger ICU workforce to keep pace.

We hypothesized that some proportion of these ICU admissions could be prevented with early and appropriate outpatient care. Such a strategy would alleviate some of the strains and costs associated with ICU stays. If an appreciable proportion of ICU stays were preventable in this way, it would strengthen support for an alternative population-health based framework instead of further investments in the ICU delivery infrastructure. 

MedicalResearch.com: What are the main findings?

Response: We found that one in six hospitalizations associated with an ICU admission might have been prevented with timely and appropriate primary care and/or palliative care referral. We identified a potentially preventable hospitalization if it met criteria for an ambulatory care sensitive condition or a life-limiting malignancy. The same pattern held across Medicare Fee-for-Service, Medicare Advantage, and a private insurance plan. 

MedicalResearch.com: What should readers take away from your report? 

Response: As the US population gets older and more complex, simply building more ICU beds may not be the best solution for patients or for society. Instead, investing in outpatient services and community health programs may be a more cost-effectiveness alternative to keeping people healthier and out of the hospital. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: We need to better understand what counts as a “preventable” admission while also understanding that the ICU is situated in the context of a larger health system. We need to study the cost-effectiveness of investments in population health management programs, including outpatient primary and palliative care services, compared to further investments in ICU beds and critical care delivery services. 

The authors have no personal or financial conflicts of interests to report.

Citation:

Potentially Preventable Intensive Care Unit Admissions in the United States, 2006 – 2015

Gary E Weissman ; ; Meeta Prasad Kerlin , Yihao Yuan , Rachel Kohn , George L Anesi , Peter W. Groeneveld ; ; Rachel M Werner ; ; Scott D Halpern

https://doi.org/10.1513/AnnalsATS.201905-366OC PubMed: 31581801

Published Online: October 04, 2019

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Last Modified : Oct 7, 2019 @ 4:47 pm 

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