Days Spent at Home and Mortality After Critical Illness: A Cluster Analysis Using Nationwide Data

BACKGROUND: Beyond the question of short-term survival, days spent at home could be considered a patient-centered outcome in critical care trials. RESEARCH QUESTION: What are the days spent at home and healthcare trajectories during the year after surviving critical illness? STUDY DESIGN AND METHODS: Data were extracted on adult survivors spending at least two nights in a French intensive care unit (ICU) during 2018 who were treated with invasive mechanical ventilation and/or vasopressors or inotropes. Trauma, burn, organ transplant, stroke and neurosurgical patients were excluded. Stays at home, death, hospitalizations were reported before and after ICU stay, using state sequence analysis. An unsupervised clustering method was performed to identify cohorts based on post-ICU trajectories. RESULTS: Of 77,132 ICU survivors, 89% returned home. In the year post-discharge, these patients spent a median 330 (IQR 283-349) days at home. At one year, 77% of patients were still at home and 17% had died. Fifty-one percent had been re-hospitalized and 10% required a further ICU admission. Forty-eight percent used rehabilitation facilities and 5.7% hospital at home. Three clusters of patients with distinct post-ICU trajectories were identified. Patients in cluster 1 (68% of total) survived and spent most of the year at home (338 (323-354) days). Patients in cluster 2 (18%) had more complex trajectories but most could return home (91%), spending 242 (174-277) days at home. Patients in cluster 3 (14%) died with only 37% returning home for 45 (15-90) days. INTERPRETATION: Many patients had complex healthcare trajectories after surviving critical illness. Wide variations in the ability to return home after ICU discharge was observed between clusters, which represents an important patient-centered outcome

Health status and drug use 1 year before and 1 year after skillednursing home admission during the first quarter of 2013in France: a study based on the French National Health InsuranceInformation System

AbstractPurpose Changes in prescribing practices following skillednursing home (SNH) admission have not been clearly describedin France. The study aimed to evaluate health status and drug use1 year before and 1 year after admission to SNH.Method People ? 65 years old admitted to SNH in the firstquarter of 2013, covered by the national health insurance generalscheme (69% of the population of this age) and still alive1 year after admission were identified in a specific database(Resid-ehpad). Linking with the National Health InsuranceInformation System (SNIIRAM) allowed analysis of theirhealth status, identified by algorithms, and changes in theiruse of reimbursed drugs.Results In a population of 11,687 residents (mean age: 86 years,women: 76%), the most prevalent diseases were cardiovascular/neurovascular diseases (45%) and dementias (35%). The use ofcertain chronic treatments (? 3 reimbursements/year) increasedsignificantly (p < 0.001) after nursing home admission: antidepressants:34 to 46%, anxiolytics: 32 to 42%, hypnotics/sedatives: 18to 24%, antipsychotics: 10 to 21% (14 to 30% in patients withdementia). The use of lipid-modifying agents and agents acting onthe renin-angiotensin system decreased significantly (33 to 24%and 44 to 37%, respectively, p < 0.001). The use of antibacterials(? 1 reimbursement/year) increased also significantly (p < 0.001):45 to 61%, including quinolones (13 to 20%) and third-generationcephalosporins (10 to 18%).Conclusion These results reveal increased prescribing of psychotropicdrugs and antibacterials in SNH, requiring the developmentor sustainability of actions designed to improve prescribingpractices in older people targeted by these treatments.Keywords Elderly . Nursing home . Drug therapy .Observational stud

Health status and drug use 1 year before and 1 year after skilled nursing home admission during the first quarter of 2013 in France: a study based on the French National Health Insurance Information System

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Underuse of primary healthcare in France during the COVID-19 epidemic in 2020 according to individual characteristics: a national observational study

International audienceBackground: The organization of healthcare systems changed significantly during the COVID-19 pandemic. The impact on the use of primary care during various key periods in 2020 has been little studied. Methods: Using individual data from the national health database, we compared the numbers of people with at least one consultation, deaths, the total number of consultations for the population of mainland France (64.3 million) and the mean number of consultations per person (differentiating between teleconsultations and consultations in person) between 2019 and 2020. We performed analyses by week, by lockdown period (March 17 to May 10, and October 30 to December 14 [less strict]), and for the entire year. Analyses were stratified for age, sex, deprivation index, epidemic level, and disease. Results: During the first lockdown, 26% of the population consulted a general practitioner (GP) at least once (-34% relative to 2019), 7.4% consulted a nurse (-28%), 1.6% a physiotherapist (-80%), and 5% a dentist (-95%). For specialists, consultations were down 82% for ophthalmologists and 37% for psychiatrists. The deficit was smaller for specialties making significant use of teleconsultations. During the second lockdown, the number of consultations was close to that in 2019, except for GPs (-7%), pediatricians (-8%), and nurses (+ 39%). Nurses had already seen a smaller increase in weekly consultations during the summer, following their authorization to perform COVID-19 screening tests. The decrease in the annual number of consultations was largest for dentists (-17%), physiotherapists (-14%), and many specialists (approximately 10%). The mean number of consultations per person was slightly lower for the various specialties, particularly for nurses (15.1 vs. 18.6). The decrease in the number of consultations was largest for children and adolescents (GPs:-10%, dentists:-13%). A smaller decrease was observed for patients with chronic diseases and with increasing age. There were 9% excess deaths, mostly in individuals over 60 years of age. Conclusions: There was a marked decrease in primary care consultations in France, especially during the first lockdown, despite strong teleconsultation activity, with differences according to age and healthcare profession. The impact of this decrease in care on morbidity and mortality merits further investigation

One-Year Survival and Hospital-Free Days in Critically Illness After Viral Pneumonia

Survivors from critical illness frequently suffer from persistent symptoms and impaired functional status (1, 2). Little is known on long-term outcomes from critical illness specifically related to viral pneumonia. The ability to return home and hospital-free days (HFDs) are important patient-centered outcomes (3–6). In this study, we investigated one-year outcomes (mortality, return to home, and HFDs) in survivors requiring Intensive Care Unit (ICU) admission for seasonal influenza or COVID-19

Association of Age With Short-term and Long-term Mortality Among Patients Discharged From Intensive Care Units in France

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Professional Cleaning Activities and Lung Cancer Risk Among Women Results From the ICARE Study

International audienceObjectives: Lung cancer risk associated with occupational cleaning activities has been investigated in the population-based case-control study ICARE. Methods: Occupational history was collected by standardized interviews. Jobs were first defined according to the International Standard Classification of Occupations (ISCO) codes and then categorized according to activity sectors. Adjusted odds ratios (ORs) were estimated by unconditional logistic regression, separately for women (619 cases and 760 controls) and men (2265 and 2780). Results: Thirty percent of women and 2.3% of men controls ever held a cleaner or care job. Women who worked as housemaids longer than 7 years showed an OR of 1.76 [95% confidence interval (95% CI) 1.09 to 2.87] with respect to controls. Women employed in domestic service sector for a long time had an OR of 2.06 (95% CI 1.15 to 3.66). Conclusion: We confirmed and redefined the association of lung cancer with occupational cleaning, which concerns a considerable proportion of women workers