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American Journal of Critical Care. 2009;18: 456-464 doi:10.4037/ajcc2009580
Copyright © 2009 by the American Association of Critical-Care Nurses.
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CE Article

Composite Outcomes of Chronically Critically Ill Patients 4 Months After Hospital Discharge

By Barbara J. Daly, RN, PhD, Sara L. Douglas, RN, PhD, Nahida H. Gordon, PhD, Carol G. Kelley, RN, PhD, E. O’Toole, MD, Hugo Montenegro, MD and Patricia Higgins, RN, PhD. Barbara J. Daly, Nahida H. Gordon, E. O’Toole, and Hugo Montenegro are professors, Sara L. Douglas and Patricia Higgins are associate professors, and Carol G. Kelley is an assistant professor at Case Western Reserve University in Cleveland, Ohio.

Corresponding author: Barbara Daly, RN, PhD, School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-4904 (e-mail: barbara.daly @case.edu).

Background Data on likely postdischarge outcomes are important for decision making about chronically critically ill patients. It seems reasonable to categorize outcomes into "better" or overall desirable states and "worse" or generally undesirable states. Survival, being at home, and being cognitively intact are commonly identified as important to quality of life and thus may be combined to describe composite outcome states.

Objective To categorize postdischarge outcome states of chronically critically ill patients and identify predictors of better and worse states.

Methods Reanalysis of data from a trial of a disease management program for chronically critically ill patients. Two composite outcomes were created: (1) the "better" outcome: no cognitive impairment at 2 months after discharge and alive and at home at 4 months (ie, met all 3 criteria), and (2) the "worse" outcome: cognitive impairment 2 months after discharge, or death after discharge, or not living at home 4 months after discharge (ie, met at least 1 of these criteria).

Results Of 218 patients not requiring ventilatory support at discharge, 111 (50.9%) had a better outcome. Of 159 patients who were cognitively intact at discharge, 111 (69.8%) had a better outcome. Of the 39 patients who required ventilatory support at discharge, only 1 (3%) achieved the better outcome. Of 98 patients who were cognitively impaired at discharge, only 29 (30%) had the better outcome.

Conclusion Need for mechanical ventilatory support and persistent cognitive impairment at discharge were associated with worse outcomes 4 months after discharge.

Notice to CE enrollees:A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Describe a method used to categorize the post-discharge outcomes states of chronically critically ill patients.
  2. Discuss the potential benefits associated with explicit discussions focused on the probable outcomes for chronically critically ill patients and families.
  3. Recognize the limitations of using survival alone as a measure of benefit for chronically critically ill patients.
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.


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Copyright © 2009 by the American Association of Critical-Care Nurses.