MiCare study, an evaluation of structured, multidisciplinary and personalised post-ICU care on physical and psychological functioning, and quality of life of former ICU patients: a study protocol of a stepped-wedge cluster randomised controlled trial

Sleeuwen, Dries van; Laar, F.A. van de; Simons, Koen S.; Bommel, Daniëlle van; Burgers-Bonthuis, Dominique; Koeter, Julia; Bisschops, Laurens L. A.; Vloet, Lilian; Brackel, Marianne; Teerenstra, Steven; Adang, Eddy; Hoeven, Johannes G. van der; Zegers, Marieke; Boogaard, Mark van den

doi:10.1136/bmjopen-2021-059634

Cited by 4 publications

(5 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For ICU survivors, an early post-discharge recovery phase is crucial, and poor rehabilitation during this period is associated with a negative outcome [31]. Leading Western countries are implementing transition programmes and post-ICU clinics to facilitate the rehabilitation of survivors [32,33]. An increasing number of extended care facilities, including nursing homes and rehabilitation hospitals, are proliferating in Korea due to the country's rapidly ageing population; however, the infrastructure, personnel and insurance payment system required to deliver professional rehabilitation in extended care facilities remain underdeveloped [34].…”

Section: Discussionmentioning

confidence: 99%

Effects of person-centred care and intensive care experience on post-intensive care syndrome in critical care survivors: a multi-centre prospective cohort study

Kang,

Yun

2024

Preprint

View full text Add to dashboard Cite

Background: Several risk factors for post-intensive care syndrome have been recognised, but the majority of them cannot be altered. While there is potential for negative experiences in the intensive care unit and person-centred care to impact post-intensive care syndrome, the evidence linking the three is insufficient. This study aimed to investigate the impact of person-centred care and the patient’s experience in the intensive care unit on post-intensive care syndrome among critical care survivors during the first year following hospital discharge. Methods: The study was a prospective, multi-centre longitudinal cohort study. This study was conducted in 19 intensive care units at four university hospitals located in Busan, South Korea. The participants were 618 adults who had been admitted to the intensive care unit for more than 24 hours between May 2019 and July 2021. At the time of intensive care unit discharge, participants completed a person-centred care and an intensive care experience questionnaire. We evaluated the post-intensive care syndrome of the participants 3, 6 and 12 months after hospital discharge. Results: The frightening experience in the intensive care unit was a factor that significantly increased post-intensive care syndrome at 3 and 6 months. Person-centred care partially mediated the impact of the frightening experience on post-intensive care syndrome, mitigating its effect. Female gender, older age, comorbidities, delirium and discharge to an extended care facility were factors that increased post-intensive care syndrome at 3, 6 and 12 months. Furthermore, comorbidities and discharge place had a statistically significant influence on the participants' post-intensive care syndrome changes over the course of one year. Conclusions: The findings of this study support the development and implementation of person-centred interventions that reduce patients' frightening experiences in the intensive care unit in order to enhance long-term outcomes. Additionally, the post-intensive care syndrome of survivors who are discharged to an extended care facility requires special attention. Registration: This study is registered at the Korean Clinical Research Information Service (#KCT0004045; date of registration: June 11, 2019; date of 1st participant recruitment: June 7, 2019).

show abstract

Section: Discussionmentioning

confidence: 99%

Effects of person-centred care and intensive care experience on post-intensive care syndrome in critical care survivors: a multi-centre prospective cohort study

Kang,

Yun

2024

Preprint

View full text Add to dashboard Cite

show abstract

“…The PROSPECT model is currently being used in a multicenter clinical trial to select high-risk patients for evaluation of post-ICU care since February 2022 ( 47 ). Variables such as complications (e.g., delirium or ICU-acquired weakness) and serious deterioration of patients were not included in the model but can still be important risk factors for post-ICU health problems.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Long-Term Physical, Mental, and Cognitive Problems Following Critical Illness: Development and External Validation of the PROSPECT Prediction Model*

van Sleeuwen,

Zegers,

Ramjith

et al. 2023

Critical Care Medicine

Self Cite

View full text Add to dashboard Cite

Objectives: ICU survivors often suffer from long-lasting physical, mental, and cognitive health problems after hospital discharge. As several interventions that treat or prevent these problems already start during ICU stay, patients at high risk should be identified early. This study aimed to develop a model for early prediction of post-ICU health problems within 48 hours after ICU admission. Design: Prospective cohort study in seven Dutch ICUs. Setting/Patients: ICU patients older than 16 years and admitted for greater than or equal to 12 hours between July 2016 and March 2020. Interventions: None. Measurements and Main Results: Outcomes were physical problems (fatigue or ≥ 3 new physical symptoms), mental problems (anxiety, depression, or post-traumatic stress disorder), and cognitive impairment. Patient record data and questionnaire data were collected at ICU admission, and after 3 and 12 months, of 2,476 patients. Several models predicting physical, mental, or cognitive problems and a composite score at 3 and 12 months were developed using variables collected within 48 hours after ICU admission. Based on performance and clinical feasibility, a model, PROSPECT, predicting post-ICU health problems at 3 months was chosen, including the predictors of chronic obstructive pulmonary disease, admission type, expected length of ICU stay greater than or equal to 2 days, and preadmission anxiety and fatigue. Internal validation using bootstrapping on data of the largest hospital (n = 1,244) yielded a C-statistic of 0.73 (95% CI, 0.70–0.76). External validation was performed on data (n = 864) from the other six hospitals with a C-statistic of 0.77 (95% CI, 0.73–0.80). Conclusions: The developed and externally validated PROSPECT model can be used within 48 hours after ICU admission for identifying patients with an increased risk of post-ICU problems 3 months after ICU admission. Timely preventive interventions starting during ICU admission and follow-up care can prevent or mitigate post-ICU problems in these high-risk patients.

show abstract

“…Although there is some optimism that reimbursement for recovery care will improve [49], the majority of critical illness recovery care programs will need to be supported by demonstration of return on investment through improved health outcomes and avoidance of downstream complications and healthcare utilization. Currently, data are mixed on the cost-effectiveness of postcritical illness programs [50][51][52], although additional cost evaluations are ongoing [39,53].…”

Section: Investment/costmentioning

confidence: 99%

“…Most studied interventions include multiple components that have not been individually tested for effectiveness and cannot be disentangled from the intervention package when a trial is complete. We need more 'ground up' intervention design using innovative methodology such as Multiphase Optimization Strategy (MOST), in which intervention components are efficiently identified for selection in an intervention using a factorial trial [53], or Sequential Multiple Assignment Randomized Trial (SMART) [54], an innovative research design that incorporates time-varying adaptive interventions. Third, recognizing the complexity and diversity of health systems in which these interventions are implemented, trials should consider methodologies that incorporate implementation evaluation and optimization.…”

Section: Future Directions In Research Developmentmentioning

confidence: 99%

“…Born and colleagues identified a subtype of sepsis survivors at the time of ICU discharge characterized by sustained organ failure and inflammation that was independently associated with poor long-term outcome. One example of an intervention that leverages an individualized approach to postcritical illness care is the ongoing MONITOR-IC post-ICU care (MiCare) study, which evaluates the effectiveness and cost-effectiveness of an individualized long-term recovery plan tailored to survivors’ patient reported outcome measures [53]. Importantly, as critical illness recovery is multidimensional, it is important to identify and prioritize what matters most to individual survivors of critical illness and their caregivers.…”

Section: Individualizing Post-critical Illness Carementioning

confidence: 99%

See 1 more Smart Citation

Health system approaches to providing posthospital care for survivors of sepsis and critical illness

Eaton,

Taylor

2023

Current Opinion in Critical Care

View full text Add to dashboard Cite

Purpose of review In the current review, we highlight developing strategies taken by healthcare systems to improve posthospital outcomes for sepsis and critical illness. Recent findings Multiple studies conducted in the adult population over the last 18 months have advanced current knowledge on postdischarge care after sepsis and critical illness. Effective interventions are complex and multicomponent, targeting the multilevel challenges that survivors face. Health systems can leverage existing care models such as primary care or invest in specialty programs to deliver postdischarge care. Qualitative and implementation science studies provide insights into important contextual factors for program success. Several studies demonstrate successful application of telehealth to improve reach of postdischarge support. Research is beginning to identify subtypes of survivors that may respond to tailored intervention strategies. Summary Several successful critical illness survivor models of care have been implemented and knowledge about effectiveness, cost, and implementation factors of these strategies is growing. Further innovation is needed in intervention development and evaluation to advance the field.

show abstract

MiCare study, an evaluation of structured, multidisciplinary and personalised post-ICU care on physical and psychological functioning, and quality of life of former ICU patients: a study protocol of a stepped-wedge cluster randomised controlled trial

Cited by 4 publications

References 24 publications

Effects of person-centred care and intensive care experience on post-intensive care syndrome in critical care survivors: a multi-centre prospective cohort study

Effects of person-centred care and intensive care experience on post-intensive care syndrome in critical care survivors: a multi-centre prospective cohort study

Prediction of Long-Term Physical, Mental, and Cognitive Problems Following Critical Illness: Development and External Validation of the PROSPECT Prediction Model*

Health system approaches to providing posthospital care for survivors of sepsis and critical illness

Contact Info

Product

Resources

About