• Nita Khandelwal, Peter May, Lois M Downey, Ruth A Engelberg, and CurtisJ RandallJRCambia Palliative Care Center of Excellence (N.K., L.M.D., R.A.E., J.R.C.), University of Washington, Harborview Medical Center, Seattle, Washington, USA; Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine (L.M..
• Department of Anesthesiology and Pain Medicine (N.K.), University of Washington, Harborview Medical Center, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence (N.K., L.M.D., R.A.E., J.R.C.), University of Washington, Harborview Medical Center, Seattle, Washington, USA. Electronic address: khandel@uw.edu.
• J Pain Symptom Manage. 2022 Apr 1; 63 (4): 618626618-626.

ContextPatients with underlying chronic illness requiring mechanical ventilation for acute respiratory failure are at risk for poor outcomes and high costs.ObjectivesIdentify characteristics at time of intensive care unit (ICU) admission that identify patients at highest risk for high-intensity, costly care.MethodsRetrospective cohort study using electronic health and financial records (2011-2017) for patients requiring ≥48 hours of mechanical ventilation with ≥1 underlying chronic condition at an academic healthcare system. Main outcome was total cost of index hospitalization. Exposures of interest included number and type of chronic conditions. We used finite mixture models to identify the highest-cost group.Results4,892 patients met study criteria. Median cost for index hospitalization was $135,238 (range, $9,748 -$3,176,065). Finite mixture modelling identified three classes with mean costs of $89,980, $150,603, and $277,712. Patients more likely to be in the high-cost class were: 1) < 72 years old (OR: 2.03; 95% CI:1.63, 2.52); 2) with dementia (OR: 1.55; 95% CI:1.17, 2.06) or chronic renal failure (OR: 1.27; 95% CI:1.08, 1.48); 3) weight loss ≥ 5% in year prior to hospital admission (OR: 1.25; 95% CI:1.05, 1.48); and 4) hospitalized during prior year (OR: 1.92; 95% CI:1.58, 2.35).ConclusionAmong patients with underlying chronic illness and acute respiratory failure, we identified characteristics associated with the highest costs of care. Identifying these patients may be of interest to healthcare systems and hospitals and serve as one indication to invest resources in palliative and supportive care programs that ensure this care is consistent with patients' goals.Copyright © 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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