Grant: Operating Grant

People who are critically ill are cared for in intensive care units (ICUs) and often require mechanical ventilation if they cannot breath on their own. Among ICU patients, the need for mechanical ventilation increases sharply with increasing age. Older people (>65 years) who have been in ICU and who have needed mechanical ventilation, are at particularly high risk of death; this increased risk lasts throughout the hospital stay, and is greatest during the first 6 months following discharge from hospital. Thus, of elderly patients who survive ICU and are discharged from hospital, 30% will have died within 6 months, and many (approximately 40%) elderly ICU survivors are rehospitalized within those first six months. We do not understand: (1) the causes of rehospitalization; (2) where patients choose to seek this additional care; or (3) how they do when they are rehospitalized. It is this overall knowledge gap that the current proposal aims to fill. We will test several key questions including: timing and causes of rehospitalizations, where people choose to be rehospitalized, and, whether outcomes are worse when rehospitalization is at a hospital that is different to where they were originally cared for when critically ill. We will answer these questions using data from all elderly patients who were cared for in ICUs and required mechanical ventilation in Ontario during the last 10 years. With a focus on decreasing rehospitalizations and costs of care, these data will inform future policy discussions regarding incentives to improve quality of care and continuity of care for very sick individuals. We will translate this knowledge into changes in patient care by publication and presentation in relevant journals and conferences (especially multidisciplinary), and by using our findings to develop knowledge translation strategies and interventions.