• Somnath Bose, Danielle Groat, Victor D Dinglas, Narjes Akhlaghi, Valerie Banner-Goodspeed, Sarah J Beesley, Tom Greene, Ramona O Hopkins, Mustafa Mir-Kasimov, Carla M Sevin, Alison E Turnbull, James C Jackson, Dale M Needham, Samuel M Brown, and Addressing Post-Intensive Care Syndrome (APICS-01) Study Team.
• Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
• Crit. Care Med. 2023 Feb 1; 51 (2): 212221212-221.

ObjectivesTo characterize early unmet nonmedication discharge needs (UDNs), classified as durable medical equipment (DME), home health services (HHS), and follow-up medical appointments (FUAs) and explore their association with 90-day readmission and mortality among survivors of acute respiratory failure (ARF) who were discharged home.DesignProspective multicenter cohort study.SettingSix academic medical centers across United States.ParticipantsAdult survivors of ARF who required an ICU stay and were discharged home from hospital.InterventionsNone. Exposure of interest was the proportion of UDN for the following categories: DME, HHS, and FUA ascertained within 7-28 days after hospital discharge.Measurements And Main ResultsTwo hundred eligible patients were recruited between January 2019 and August 2020. One-hundred ninety-five patients were included in the analytic cohort: 118 were prescribed DME, 134 were prescribed HHS, and 189 needed at least one FUA according to discharge plans. 98.4% (192/195) had at least one identified nonmedication need at hospital discharge. Median (interquartile range) proportion of unmet needs across three categories were 0 (0-15%) for DME, 0 (0-50%) for HHS, and 0 (0-25%) for FUA, and overall was 0 (0-20%). Fifty-six patients (29%) had 90-day death or readmission. After adjusting for prespecified covariates, having greater than the median level of unmet needs was not associated with an increased risk of readmission or death within 90 days of discharge (risk ratio, 0.89; 0.51-1.57; p = 0.690). Age, hospital length of stay, Acute Physiology and Chronic Health Evaluation II severity of illness score, and Multidimensional Scale Perceived Social Support score were associated with UDN.ConclusionsUDN were common among survivors of ARF but not significantly associated a composite outcome of 90-day readmission or death. Our results highlight the substantial magnitude of UDN and identifies areas especially vulnerable to lapses in healthcare coordination.Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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