Provision of critical care for the elderly in Europe: a retrospective comparison of national healthcare frameworks in intensive care units

VIP2 study group; Bernhard Wernly; Michael Beil; Raphael Romano Bruno; Stephan Binnebössel; Malte Kelm; Sviri Sigal; Peter Vernon van Heerden; Ariane Boumendil; Antonio Artigas; Maurizio Cecconi; Brian Marsh; Rui Moreno; Sandra Oeyen; Bernardo Bollen Pinto; Wojciech Szczeklik; Susannah Leaver; Sten Mikael Walther; Joerg C Schefold; Michael Joannidis; Jesper Fjølner; Tilemachos Zafeiridis; Dylan de Lange; Bertrand Guidet; Hans Flaatten; Christian Jung

doi:10.1136/bmjopen-2020-046909

Provision of critical care for the elderly in Europe: a retrospective comparison of national healthcare frameworks in intensive care units

VIP2 study group, Bernhard Wernly, Michael Beil, Raphael Romano Bruno, Stephan Binnebössel, Malte Kelm, Sviri Sigal, Peter Vernon van Heerden, Ariane Boumendil, Antonio Artigas, Maurizio Cecconi, Brian Marsh, Rui Moreno, Sandra Oeyen, Bernardo Bollen Pinto, Wojciech Szczeklik, Susannah Leaver, Sten Mikael Walther, Joerg C Schefold, Michael JoannidisJesper Fjølner, Tilemachos Zafeiridis, Dylan de Lange, Bertrand Guidet, Hans Flaatten, Christian Jung

11 Zitate (Scopus)

Abstract

OBJECTIVES: In Europe, there is a distinction between two different healthcare organisation systems, the tax-based healthcare system (THS) and the social health insurance system (SHI). Our aim was to investigate whether the characteristics, treatment and mortality of older, critically ill patients in the intensive care unit (ICU) differed between THS and SHI.

SETTING: ICUs in 16 European countries.

PARTICIPANTS: In total, 7817 critically ill older (≥80 years) patients were included in this study, 4941 in THS and 2876 in the SHI systems.

PRIMARY AND SECONDARY OUTCOMES MEASURES: We chose generalised estimation equations with robust standard errors to produce population average adjusted OR (aOR). We adjusted for patient-specific variables, health economic data, including gross domestic product (GDP) and human development index (HDI), and treatment strategies.

RESULTS: In SHI systems, there were higher rates of frail patients (Clinical Frailty Scale>4; 46% vs 41%; p<0.001), longer length of ICU stays (90±162 vs 72±134 hours; p<0.001) and increased levels of organ support. The ICU mortality (aOR 1.50, 95% CI 1.09 to 2.06; p=0.01) was consistently higher in the SHI; however, the 30-day mortality (aOR 0.89, 95% CI 0.66 to 1.21; p=0.47) was similar between THS and SHI. In a sensitivity analysis stratifying for the health economic data, the 30-day mortality was higher in SHI, in low GDP per capita (aOR 2.17, 95% CI 1.42 to 3.58) and low HDI (aOR 1.22, 95% CI 1.64 to 2.20) settings.

CONCLUSIONS: The 30-day mortality was similar in both systems. Patients in SHI were older, sicker and frailer at baseline, which could be interpreted as a sign for a more liberal admission policy in SHI. We believe that the observed trend towards ICU excess mortality in SHI results mainly from a more liberal admission policy and an increase in treatment limitations.

TRIAL REGISTRATION NUMBERS: NCT03134807 and NCT03370692.

Originalsprache	Englisch
Zeitschrift	BMJ Open
Jahrgang	11
Ausgabenummer	6
Seiten (von - bis)	e046909
ISSN	2044-6055
DOIs	https://doi.org/10.1136/bmjopen-2020-046909
Publikationsstatus	Veröffentlicht - 03.06.2021
Extern publiziert	Ja

DFG-Fachsystematik

2.22-02 Public Health, gesundheitsbezogene Versorgungsforschung, Sozial- und Arbeitsmedizin

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10.1136/bmjopen-2020-046909

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VIP2 study group, Wernly, B., Beil, M., Bruno, R. R., Binnebössel, S., Kelm, M., Sigal, S., van Heerden, P. V., Boumendil, A., Artigas, A., Cecconi, M., Marsh, B., Moreno, R., Oeyen, S., Bollen Pinto, B., Szczeklik, W., Leaver, S., Walther, S. M., Schefold, J. C., ... Jung, C. (2021). Provision of critical care for the elderly in Europe: a retrospective comparison of national healthcare frameworks in intensive care units. BMJ Open, 11(6), e046909. https://doi.org/10.1136/bmjopen-2020-046909

@article{d786a1bf1c024fc6b89aedc7ce8cf8ef,

title = "Provision of critical care for the elderly in Europe: a retrospective comparison of national healthcare frameworks in intensive care units",

abstract = "OBJECTIVES: In Europe, there is a distinction between two different healthcare organisation systems, the tax-based healthcare system (THS) and the social health insurance system (SHI). Our aim was to investigate whether the characteristics, treatment and mortality of older, critically ill patients in the intensive care unit (ICU) differed between THS and SHI.SETTING: ICUs in 16 European countries.PARTICIPANTS: In total, 7817 critically ill older (≥80 years) patients were included in this study, 4941 in THS and 2876 in the SHI systems.PRIMARY AND SECONDARY OUTCOMES MEASURES: We chose generalised estimation equations with robust standard errors to produce population average adjusted OR (aOR). We adjusted for patient-specific variables, health economic data, including gross domestic product (GDP) and human development index (HDI), and treatment strategies.RESULTS: In SHI systems, there were higher rates of frail patients (Clinical Frailty Scale>4; 46\% vs 41\%; p<0.001), longer length of ICU stays (90±162 vs 72±134 hours; p<0.001) and increased levels of organ support. The ICU mortality (aOR 1.50, 95\% CI 1.09 to 2.06; p=0.01) was consistently higher in the SHI; however, the 30-day mortality (aOR 0.89, 95\% CI 0.66 to 1.21; p=0.47) was similar between THS and SHI. In a sensitivity analysis stratifying for the health economic data, the 30-day mortality was higher in SHI, in low GDP per capita (aOR 2.17, 95\% CI 1.42 to 3.58) and low HDI (aOR 1.22, 95\% CI 1.64 to 2.20) settings.CONCLUSIONS: The 30-day mortality was similar in both systems. Patients in SHI were older, sicker and frailer at baseline, which could be interpreted as a sign for a more liberal admission policy in SHI. We believe that the observed trend towards ICU excess mortality in SHI results mainly from a more liberal admission policy and an increase in treatment limitations.TRIAL REGISTRATION NUMBERS: NCT03134807 and NCT03370692.",

author = "\{VIP2 study group\} and Bernhard Wernly and Michael Beil and Bruno, \{Raphael Romano\} and Stephan Binneb{\"o}ssel and Malte Kelm and Sviri Sigal and \{van Heerden\}, \{Peter Vernon\} and Ariane Boumendil and Antonio Artigas and Maurizio Cecconi and Brian Marsh and Rui Moreno and Sandra Oeyen and \{Bollen Pinto\}, Bernardo and Wojciech Szczeklik and Susannah Leaver and Walther, \{Sten Mikael\} and Schefold, \{Joerg C\} and Michael Joannidis and Jesper Fj{\o}lner and Tilemachos Zafeiridis and \{de Lange\}, Dylan and Bertrand Guidet and Hans Flaatten and Christian Jung",

note = "{\textcopyright} Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2021",

month = jun,

day = "3",

doi = "10.1136/bmjopen-2020-046909",

language = "English",

volume = "11",

pages = "e046909",

journal = "BMJ Open",

issn = "2044-6055",

number = "6",

}

VIP2 study group, Wernly, B, Beil, M, Bruno, RR, Binnebössel, S, Kelm, M, Sigal, S, van Heerden, PV, Boumendil, A, Artigas, A, Cecconi, M, Marsh, B, Moreno, R, Oeyen, S, Bollen Pinto, B, Szczeklik, W, Leaver, S, Walther, SM, Schefold, JC, Joannidis, M, Fjølner, J, Zafeiridis, T, de Lange, D, Guidet, B, Flaatten, H & Jung, C 2021, 'Provision of critical care for the elderly in Europe: a retrospective comparison of national healthcare frameworks in intensive care units', BMJ Open, Jg. 11, Nr. 6, S. e046909. https://doi.org/10.1136/bmjopen-2020-046909

TY - JOUR

T1 - Provision of critical care for the elderly in Europe

T2 - a retrospective comparison of national healthcare frameworks in intensive care units

AU - VIP2 study group

AU - Wernly, Bernhard

AU - Beil, Michael

AU - Bruno, Raphael Romano

AU - Binnebössel, Stephan

AU - Kelm, Malte

AU - Sigal, Sviri

AU - van Heerden, Peter Vernon

AU - Boumendil, Ariane

AU - Artigas, Antonio

AU - Cecconi, Maurizio

AU - Marsh, Brian

AU - Moreno, Rui

AU - Oeyen, Sandra

AU - Bollen Pinto, Bernardo

AU - Szczeklik, Wojciech

AU - Leaver, Susannah

AU - Walther, Sten Mikael

AU - Schefold, Joerg C

AU - Joannidis, Michael

AU - Fjølner, Jesper

AU - Zafeiridis, Tilemachos

AU - de Lange, Dylan

AU - Guidet, Bertrand

AU - Flaatten, Hans

AU - Jung, Christian

PY - 2021/6/3

Y1 - 2021/6/3

N2 - OBJECTIVES: In Europe, there is a distinction between two different healthcare organisation systems, the tax-based healthcare system (THS) and the social health insurance system (SHI). Our aim was to investigate whether the characteristics, treatment and mortality of older, critically ill patients in the intensive care unit (ICU) differed between THS and SHI.SETTING: ICUs in 16 European countries.PARTICIPANTS: In total, 7817 critically ill older (≥80 years) patients were included in this study, 4941 in THS and 2876 in the SHI systems.PRIMARY AND SECONDARY OUTCOMES MEASURES: We chose generalised estimation equations with robust standard errors to produce population average adjusted OR (aOR). We adjusted for patient-specific variables, health economic data, including gross domestic product (GDP) and human development index (HDI), and treatment strategies.RESULTS: In SHI systems, there were higher rates of frail patients (Clinical Frailty Scale>4; 46% vs 41%; p<0.001), longer length of ICU stays (90±162 vs 72±134 hours; p<0.001) and increased levels of organ support. The ICU mortality (aOR 1.50, 95% CI 1.09 to 2.06; p=0.01) was consistently higher in the SHI; however, the 30-day mortality (aOR 0.89, 95% CI 0.66 to 1.21; p=0.47) was similar between THS and SHI. In a sensitivity analysis stratifying for the health economic data, the 30-day mortality was higher in SHI, in low GDP per capita (aOR 2.17, 95% CI 1.42 to 3.58) and low HDI (aOR 1.22, 95% CI 1.64 to 2.20) settings.CONCLUSIONS: The 30-day mortality was similar in both systems. Patients in SHI were older, sicker and frailer at baseline, which could be interpreted as a sign for a more liberal admission policy in SHI. We believe that the observed trend towards ICU excess mortality in SHI results mainly from a more liberal admission policy and an increase in treatment limitations.TRIAL REGISTRATION NUMBERS: NCT03134807 and NCT03370692.

AB - OBJECTIVES: In Europe, there is a distinction between two different healthcare organisation systems, the tax-based healthcare system (THS) and the social health insurance system (SHI). Our aim was to investigate whether the characteristics, treatment and mortality of older, critically ill patients in the intensive care unit (ICU) differed between THS and SHI.SETTING: ICUs in 16 European countries.PARTICIPANTS: In total, 7817 critically ill older (≥80 years) patients were included in this study, 4941 in THS and 2876 in the SHI systems.PRIMARY AND SECONDARY OUTCOMES MEASURES: We chose generalised estimation equations with robust standard errors to produce population average adjusted OR (aOR). We adjusted for patient-specific variables, health economic data, including gross domestic product (GDP) and human development index (HDI), and treatment strategies.RESULTS: In SHI systems, there were higher rates of frail patients (Clinical Frailty Scale>4; 46% vs 41%; p<0.001), longer length of ICU stays (90±162 vs 72±134 hours; p<0.001) and increased levels of organ support. The ICU mortality (aOR 1.50, 95% CI 1.09 to 2.06; p=0.01) was consistently higher in the SHI; however, the 30-day mortality (aOR 0.89, 95% CI 0.66 to 1.21; p=0.47) was similar between THS and SHI. In a sensitivity analysis stratifying for the health economic data, the 30-day mortality was higher in SHI, in low GDP per capita (aOR 2.17, 95% CI 1.42 to 3.58) and low HDI (aOR 1.22, 95% CI 1.64 to 2.20) settings.CONCLUSIONS: The 30-day mortality was similar in both systems. Patients in SHI were older, sicker and frailer at baseline, which could be interpreted as a sign for a more liberal admission policy in SHI. We believe that the observed trend towards ICU excess mortality in SHI results mainly from a more liberal admission policy and an increase in treatment limitations.TRIAL REGISTRATION NUMBERS: NCT03134807 and NCT03370692.

U2 - 10.1136/bmjopen-2020-046909

DO - 10.1136/bmjopen-2020-046909

M3 - Journal articles

C2 - 34083342

SN - 2044-6055

VL - 11

SP - e046909

JO - BMJ Open

JF - BMJ Open

IS - 6

ER -

Provision of critical care for the elderly in Europe: a retrospective comparison of national healthcare frameworks in intensive care units

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