Telehealth care model benefits high-risk veterans transitioning from ICU to home

Key takeaways:

• Challenges arise during a patient’s transition from the ICU.
• Nearly 47% of veterans discharged to home had a high risk for 1-year mortality.

SAN DIEGO — Among high-risk veterans discharged from the ICU, a telehealth care model reduced mortality and led to more hospital-free days, according to research presented at the American Thoracic Society International Conference.

The Post-Acute Recovery Center (PARC) telehealth transitional care model is designed to aid high-risk patients after the ICU and is led by nurse practitioners, according to the study abstract.

“Post-intensive care clinics have emerged as a mechanism of identifying new health conditions and easing the transition back to home life but have not been shown to be consistently or convincingly successful,” Hiam Naiditch, MD, MHS, pulmonary and critical care fellow at University of Pittsburgh Medical Center, told Healio.

“Our results are preliminary, but if confirmed in a large, randomized control trial, could provide a model for improving transitional care for ICU survivors,” Naiditch added.

In a retrospective analysis, Naiditch and colleagues evaluated 195 veterans receiving care after the ICU at VA Pittsburgh to determine differences in hospital-free days and mortality between veterans receiving care under the PARC model vs. veterans not receiving care under the PARC.

Researchers grouped veterans according to their 1-year mortality risk following discharge, which was based on the score they received from the validated PREDICT risk assessment tool. A score over 15 signaled a veteran at high risk.

Of those receiving PARC care, researchers identified 65 high-risk veterans and matched them 1:2 via coarsened exact matching to veterans at VA Pittsburgh not receiving care following the PARC model (n = 130). Matching was done with consideration for several variables: age group, sex, race, Elixhauser score and PREDICT score.

Between the two sets of veterans, 90-day mortality was lower in the PARC group vs. the non-PARC group (23.1% vs. 39.2%; absolute risk reduction [ARR] = 16.1).

By day 90, veterans in the PARC group also spent more days at home (median, 4 days) than veterans in the non-PARC group, according to researchers.

“Post-ICU clinics have had varied outcomes,” Naiditch said. “We saw a compelling association between enrollment in our clinic, mortality and hospital-free days, which we and others believe are most important to our patients.

“The significant reduction in risk (ARR = 16.1, which translates into a number needed to treat of roughly six to seven patients) was surprising, although we should emphasize that further analysis is needed to confirm these preliminary observational results,” he added.

In an additional analysis, researchers assessed 68,420 veterans discharged from a VA medical center in 2020 following critical illness to see how these outcomes differ between high-risk (n = 32,060 [46.9%]; median age, 74 years; 95.8% men; 67.6% white) and low-risk veterans.

A greater percentage of high-risk vs. low-risk veterans died by day 90 (18.2% vs. 4.8%; P < .01). At the same 90-day checkpoint, researchers found 2 fewer days at home in the group of high-risk veterans.

According to a press release from ATS, future research on the PARC model will include several northeastern U.S. VA facilities in a randomized trial.

“Further analyses will be needed to confirm our results,” Naiditch told Healio. “Additional sites are being engaged as part of a randomized trial for PARC. We are actively working on this next step.”

References:

• PARC model of care associated with fewer deaths among veterans post-ICU. https://site.thoracic.org/about-us/news/2024-international-conference-press-release/parc-model-of-care-associated-with-fewer-deaths-among-veterans-post-icu. Published May 20, 2024. Accessed May 20, 2024.
• Naiditch H, et al. Am J Respir Crit Care Med. 2024;doi:10.1154/ajrccm-conference.2024.209.1_MeetingAbstracts.A3036.