Admitting older, low-risk patients with pneumonia to the intensive-care unit — compared with admission to regular wards — is linked with higher survival rates but not higher medical expenses, new research suggests.
Researchers led by Dr. Thomas Valley of the University of Michigan analyzed the link between intensive care admissions and outcomes among older people hospitalized for pneumonia as well as 30-day death rates and overall medical costs. The study included more than 1 million Medicare beneficiaries older than age 64 who were admitted to nearly 3,000 U.S. hospitals for pneumonia from 2010 to 2012.
Of those, 30 percent were admitted to the ICU. Meanwhile, 36 percent of those living within roughly 3 miles of the hospital were admitted to the ICU compared to 23 percent of those who lived farther away.
Of the 13 percent of patients whose admission appeared to be dependent only on distance, survival rates were higher among those treated in the ICU than in general wards. Researchers pointed out that Medicare spending and hospital costs were comparable. The study was published Sept. 22 in the journal JAMA.
“A randomized trial may be warranted to assess whether more liberal ICU admission policies improve mortality for patients with pneumonia,” the study authors wrote. The research only found an association, rather than a cause-and-effect relationship, between ICU admission rates and survival.
The findings argue against efforts to reduce ICU admissions, at least for older patients with pneumonia, Dr. Ian Barbash and Dr. Jeremy Kahn of the University of Pittsburgh School of Medicine wrote in an accompanying editorial.
“The greatest lesson from this study may be that low-value health care is difficult to find,” they wrote. “Reducing health care spending by preventing ICU readmissions will require addressing the difficult questions about rationing ICU care and the degree to which the nation can afford to make intensive care available to anyone at any time.”
Barbash and Kahn wrote that the task now is to determine why intensive care saves lives, and then to use that information to make care as safe and effective for all patients, no matter where in the hospital they are treated.
The Kaiser Family Foundation provides more information on health care costs.
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