Economic stress and misaligned incentives in critical care medicine in the United States

Abstract

It is in the best interest of the care of our patients that critical care providers increase awareness of the many factors influencing our practice economically. It is through such understanding that challenges can be met, solutions can be found, and the quality of intensive care can be improved in a financially sustainable environment.

An economic evaluation of prolonged mechanical ventilation*

“…There have been recent calls within the critical care field for greater attention to economic analyses of critical care from both clinicians and policymakers (14,15). Despite the high costs of PMV and often poor outcomes, there have been no formal economic analyses of PMV provision that incorporate either a lifetime time horizon or the contributions of acute as well as postacute care costs.…”

Can outcome prediction data change patient outcomes and organizational outcomes?

“…As with any measure, there may be a risk of overinterpretation of such indicators. Further, concentrating solely on indicators can divert attention away from genuine improvement to superficial improvement, and there may be a risk of manipulation of data (gaming) [20,21]. We should thus aim at making the important measureable rather than making the measurable important.…”

Economic evaluation of propofol and lorazepam for critically ill patients undergoing mechanical ventilation*

“…(30) Therefore, the results of our economic analysis have contemporary importance for physicians, pharmacists, administrators, and policymakers and add to the relatively small body of critical care costeffectiveness research. (15,31) We believe that there is a common perception that propofol use is inherently expensive in comparison to lorazepam and that favoring the latter in routine clinical practice may conserve resources. (32) However, our analyses show that propofol has superior value when compared to lorazepam and may have equivalent value to midazolam when daily interruption of sedation occurs.…”

“…(14) Because of the strong association between ICU length of stay and costs, identification of safe and effective sedative options that can also reduce resource utilization during a time of changing population demographics is important for policymakers and clinicians alike. (15,16) However, we know of no formal economic analyses comparing sedatives in the setting of contemporary critical care practice. Therefore, we performed cost-effectiveness analysis comparing continuous propofol and intermittent lorazepam for the sedation of critically ill adults with secondary analyses including midazolam.…”