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Public versus Private Healthcare Systems following Discharge from the ICU: A Propensity Score-Matched Comparison of Outcomes.

Dexheimer Neto FL, Rosa RG, Duso BA, Haas JS, Savi A, Cabral Cda R, Maccari JG, de Oliveira RP, Antônio AC, Castro Pde S, Teixeira C - Biomed Res Int (2016)

Bottom Line: The results of the PS-matched comparison of all-cause mortality revealed higher mortality rates among the patients of the public healthcare system compared to those of the private healthcare system (47.3% versus 27.6%, P = 0.003).Conclusions.The patients of private healthcare system exhibited significantly greater survival rates than the patients of the public healthcare system with similar PFS following ICU discharge.

View Article: PubMed Central - PubMed

Affiliation: Department of Critical Care, Hospital Moinhos de Vento, Ramiro Barcelos 910/605, 90035-001 Porto Alegre, RS, Brazil.

ABSTRACT
Purpose. The long-term outcomes of patients after discharge from tertiary ICUs as they relate to the public versus private healthcare systems in Brazil have not yet been evaluated. Materials and Methods. A multicenter prospective cohort study was conducted to compare the all-cause mortality and the physical functional status (PFS) 24 months after discharge from the ICU between adult patients treated in the public and private healthcare systems. A propensity score- (PS-) matched comparison of all causes of mortality and PFS 24 months after discharge from the ICU was performed. Results. In total, 928 patients were discharged from the ICU including 172 (18.6%) patients in the public and 756 (81.4%) patients in the private healthcare system. The results of the PS-matched comparison of all-cause mortality revealed higher mortality rates among the patients of the public healthcare system compared to those of the private healthcare system (47.3% versus 27.6%, P = 0.003). The comparison of the PS-matched Karnofsky performance and Lawton activities of daily living scores between the ICU survivors of the public and private healthcare systems revealed no significant differences. Conclusions. The patients of private healthcare system exhibited significantly greater survival rates than the patients of the public healthcare system with similar PFS following ICU discharge.

No MeSH data available.


Distributions of the propensity scores of the critical care patients according to healthcare status after propensity matching.
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fig3: Distributions of the propensity scores of the critical care patients according to healthcare status after propensity matching.

Mentions: Table 2 illustrates the multivariate logistic regression analysis of the factors associated with treatment in the public healthcare system. Younger patients and patients with higher ICU admission APACHE-II and ICU day of discharge SOFA scores were more likely to be treated in the public healthcare system. Additionally, the needs for mechanical ventilation and RRT during the ICU stay were greater in the patients who were treated in the public healthcare system. The results of this logistic regression model were used to build the PS. The distribution of PSs according to healthcare status after propensity score matching is displayed in Figure 3.


Public versus Private Healthcare Systems following Discharge from the ICU: A Propensity Score-Matched Comparison of Outcomes.

Dexheimer Neto FL, Rosa RG, Duso BA, Haas JS, Savi A, Cabral Cda R, Maccari JG, de Oliveira RP, Antônio AC, Castro Pde S, Teixeira C - Biomed Res Int (2016)

Distributions of the propensity scores of the critical care patients according to healthcare status after propensity matching.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4829690&req=5

fig3: Distributions of the propensity scores of the critical care patients according to healthcare status after propensity matching.
Mentions: Table 2 illustrates the multivariate logistic regression analysis of the factors associated with treatment in the public healthcare system. Younger patients and patients with higher ICU admission APACHE-II and ICU day of discharge SOFA scores were more likely to be treated in the public healthcare system. Additionally, the needs for mechanical ventilation and RRT during the ICU stay were greater in the patients who were treated in the public healthcare system. The results of this logistic regression model were used to build the PS. The distribution of PSs according to healthcare status after propensity score matching is displayed in Figure 3.

Bottom Line: The results of the PS-matched comparison of all-cause mortality revealed higher mortality rates among the patients of the public healthcare system compared to those of the private healthcare system (47.3% versus 27.6%, P = 0.003).Conclusions.The patients of private healthcare system exhibited significantly greater survival rates than the patients of the public healthcare system with similar PFS following ICU discharge.

View Article: PubMed Central - PubMed

Affiliation: Department of Critical Care, Hospital Moinhos de Vento, Ramiro Barcelos 910/605, 90035-001 Porto Alegre, RS, Brazil.

ABSTRACT
Purpose. The long-term outcomes of patients after discharge from tertiary ICUs as they relate to the public versus private healthcare systems in Brazil have not yet been evaluated. Materials and Methods. A multicenter prospective cohort study was conducted to compare the all-cause mortality and the physical functional status (PFS) 24 months after discharge from the ICU between adult patients treated in the public and private healthcare systems. A propensity score- (PS-) matched comparison of all causes of mortality and PFS 24 months after discharge from the ICU was performed. Results. In total, 928 patients were discharged from the ICU including 172 (18.6%) patients in the public and 756 (81.4%) patients in the private healthcare system. The results of the PS-matched comparison of all-cause mortality revealed higher mortality rates among the patients of the public healthcare system compared to those of the private healthcare system (47.3% versus 27.6%, P = 0.003). The comparison of the PS-matched Karnofsky performance and Lawton activities of daily living scores between the ICU survivors of the public and private healthcare systems revealed no significant differences. Conclusions. The patients of private healthcare system exhibited significantly greater survival rates than the patients of the public healthcare system with similar PFS following ICU discharge.

No MeSH data available.