Leanne Boehm, PhD, RN
Assistant Professor
Vanderbilt University
Nashville, Tennessee
Disclosure information not submitted.
Marianna LaNoue, PhD
Professor
Vanderbilt University School of Nursing, United States
Disclosure information not submitted.
Valerie Danesh, PhD, RN, , FCCM
Research Scientist
Baylor Scott and White Health
Dallas, Texas
Disclosure information not submitted.
.jpg "Carla Sevin, MD photo")
Carla Sevin, MD
Director, ICU Recovery Center at Vanderbilt
Vanderbilt University Medical Center
Nashville, Tennessee
Disclosure information not submitted.
Title: Factors Influencing ICU Survivor Utilization of Recovery Services Via an In-person PICS Clinic
Introduction: Post-intensive care syndrome (PICS) clinics are a feasible and promising intervention to address the sequelae of critical illness. A significant number of intensive care unit (ICU) survivors are unable to attend in-person PICS clinics due to resource barriers and/or physical limitations affecting stamina. For many ICU survivors travel to clinics is difficult, or they cannot attend in person.
Methods: Quality improvement data were collected from 2012 to 2020 on 564 patients referred to the PICS clinic at an academic medical center in the southeast United States. We used logistic regression models for the likelihood of scheduling and completing an appointment based on patient age (18-44, 45-64, ≥65), sequential organ failure assessment (SOFA), and home-to-clinic distance.
Results: In univariate models, there was a decreasing likelihood of scheduling a PICS clinic visit for older age categories (45-64; ≥65) relative to the youngest (18-44). The SOFA score was also significant and shows a decreasing likelihood for each incremental SOFA score increase. In a multivariable logistic regression using the same predictors and interactions, both home-to-clinic distance and age, as well as an age-by-distance interaction, were significant. The coefficients indicate decreasing likelihood of scheduling a follow-up visit for every additional mile of distance the patient lives from the PICS clinic (β=-0.12, OR=.988), and for patients ≥65 years old (β=-1.72, OR=.180). We also used multivariable logistic regression for the likelihood of a ‘no-show’ to a scheduled PICS clinic visit using the same predictors. In this model patients with the highest ICU acuity were the most likely to follow through with scheduled in-person visits (β=0.11, OR=1.18).
Conclusion: Our data suggest that older ICU survivors and those who live farther from the clinic site are less likely to engage in an in-person PICS clinic visit. Furthermore, those with higher ICU acuity (i.e., SOFA), and likely most in need of coordinated ICU recovery services, are less likely to schedule an appointment. Alternative delivery strategies via telehealth could address these access to care limitations for recovery services via PICS clinics.