Critical Care at the End of Life: A Population-Level Retrospective Cohort Study of Cost and Outcomes in Ontario
CCCF ePoster library. Chaudhuri D. Oct 31, 2016; 155976; ORAL
Dipayan Chaudhuri
Dipayan Chaudhuri
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Topic: Retrospective or Prospective Cohort Study

Critical Care at the End of Life: A Population-Level Retrospective Cohort Study of Cost and Outcomes in Ontario

Chaudhuri, Dipayan1,2; Tanuseptro, Peter3,4,5; Herritt, Brent1,2, D'Egidio, Gianni1,2; Chalifoux, Mathieu3; Kyeremanteng, Kwadwo1,6
1Division of Critical Care, The Ottawa Hospital, Ottawa, Canada; 2Department of Medicine, The Ottawa Hospital, Ottawa, Canada; 3Bruyere Research Institute, Bruyere Centre of Learning, Research and Innovation in Long-Term Care, Ottawa, Canada; 4Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; 5Institute for Clinical Evaluation Sciences, Ottawa, Canada; 6Division of Palliative Care, The Ottawa Hospital, Ottawa, Canada.



Background: Despite the high cost associated with ICU use at the end-of-life, very little is known at a population level about the characteristics of users and their end-of-life experience.
Objectives: In this study, our goal was to characterize decedents who received intensive care near the end of life and examine their overall health care use prior to death.
Methods: We conducted a retrospective cohort study examining health care use and cost incurred by decedents in their last 90 days of life. We captured all deaths in a 3-year period, from April 1, 2010 to March 31, 2013 in Ontario, Canada. Deaths were identified using the Ontario Registered Persons Database (RPDB). All records of health care use paid for by the provincial Ministry of Health and Long Term Care (MOHLTC) in the last year of life were also retrieved.
Results: Overall, 264 754 individuals were included in the study, of which 18% used ICU in the last 90 days of life. 34.5% of these ICU users were greater than 80 years of age and 53.0% had greater than 5 chronic conditions. The average cost of stay for these decedents was $15, 511 to $25,526 greater than those who were not admitted to ICU, across varying levels of comorbidity. These individuals also died more in hospital (88.7% vs 36.2%), were readmitted more (40.2% vs 16.9%), spent more time in acute care settings (18.7 days vs. 10.5 days) and had more aggressive care measures, such as CPR (11.5% vs 1.0%) and feeding tube insertions (4.2% vs 0.9%) performed.
Conclusion: Contrary to the notion that older, frail and multi-morbid individuals close to death may be inappropriate for ICU care, we show – at a population level – that a significant proportion of those with ICU use close to death are actually older and multi-morbid. Not only does this incur significantly greater costs on already limited resources, but we also show that this leads to increased deaths in hospital and increased rates of aggressive care measures that are ultimately futile. More work needs to explore the appropriateness of ICU admission at the end of life, as determined by the patient’s wishes and their overall medical condition.

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