(313) ICU Survivor Clinic Provides a Mortality Benefit Compared to Usual Care

Introduction: ICU survivors have a high rate of mortality and readmission post hospital discharge. ICU survivor care clinics have attempted to mitigate both mortality and readmission risk with little reported success worldwide. We previously reported our 13-month ICU Survivor Clinic (ICU SC) versus Usual Care (UC) experience, including a statistically significant mortality benefit but no readmission rate benefit. We now present our three-year experience and the impact on 30- and 60- day readmission rates and one year mortality rates.

Methods: Retrospective cohort study at a rural tertiary teaching hospital with adult medical, surgical, neuroscience, cardiac and trauma ICUs. Eligible patients were adult survivors of ICU admissions for sepsis of any degree of severity, or mechanical ventilation for 2+ days, or ICU delirium of 4+ days and had a Geisinger Health Plan insurance plan, a Medicare plan with a Geisinger primary care provider (PCP) or enrolled in Keystone Accountable Care Organization (KACO) with a Geisinger PCP. Study period is November 1, 2016, to December 31, 2019. Primary endpoints were mortality and readmission rates.

Results: 346 patients were eligible and offered participation in the ICU SC care process. 93 accepted and fully participated (telephone follow up and clinic visits), 72 accepted but partially participated (phone follow up but no clinic visit), 7 accepted but never participated, and 174 declined offer to participate and had UC with their PCP. There was no difference in readmission rates at 30 days (ICU SC 59.1% vs UC 60.3%) or 60 days (ICU SC 64.5% vs. UC 68.4%). There was a statistically significant mortality benefit at one year, ICU SC 18.3% vs. UC 42.5%, Chi-Square P value < 0.0001). Mortality benefit was also seen in partial participants in ICU SC, 26.4% versus 42.5% in UC (Chi-Square p value = 0.0175)

Conclusions: Our ICU SC care process appears to offer a mortality benefit compared to UC processes. The most robust mortality benefit comes with full participation in ICU SC, but there is a significant mortality benefit for partial participation compared to usual care. There was no readmission rate benefit at 30- or 60 days post discharge from index hospital admission from participation in ICU SC versus usual care.