Medicaid beneficiaries who receive ICU care while hospitalized are more likely to die in the year after discharge than their peers on private insurance — and the disparity is worst among those with a critical illness who are discharged to a nursing home.
That’s according to a study by Yoland Philpotts, M.D., of the Columbia University College of Physicians & Surgeons, who reported the findings at this week’s American Thoracic Society International Conference in San Diego.
The researchers used the New York Statewide Planning and Research Cooperative System database and American Hospital Association Annual Survey to examine post-discharge mortality of New Yorkers age 65 and older who had their first hospitalization in intensive care, and survived while in the hospital. They looked at 339,261 New York State cases between 2010 and 2014.
Philpotts found that 20% of those who survived while in the ICU died within one year of hospital discharge.
But Medicaid patients had a 15% increased risk of death compared to those with commercial insurance, he said.
In addition to looking at whether there were differences in death rates for patients with co-existing health conditions or who had more severe critical illness, the team examined if differences in age, race or household income affected patients’ post-hospital one-year mortality rates. They also separated out teaching hospitals from non-teaching hospitals, and urban from rural hospitals.
None of these factors made a significant difference in patient mortality rates.
“The implications of our findings are important: to improve the long-term survival and quality-of-life of critical illness survivors, we may have to improve care not only within the hospital and ICU, but also after hospital discharge,” Philpotts said in a press release. “We now need further studies aimed at identifying the factors that mediate the higher mortality among ICU survivors who lack commercial insurance.” said Dr. Philpotts. “Our team will study insurance status and readmission to the hospital after critical illness for this vulnerable patient population. A readmission to the hospital after critical illness is a potential marker of a barrier to high-quality care after discharge.”
Specifically, he said future investigations should examine care disparities at skilled-care facilities that may mediate higher mortality rates among poor, older survivors of critical illness.