Could an integrated model of health and social care after critical illness reduce socioeconomic disparities in outcomes? A Bayesian analysis

McPeake, J., Iwashyna, T. J., Mactavish, P., Devine, H., Henderson, P., Quasim, T. and Shaw, M. (2024) Could an integrated model of health and social care after critical illness reduce socioeconomic disparities in outcomes? A Bayesian analysis. BJA Open, 9, 100259. (doi: 10.1016/j.bjao.2024.100259) (PMID:38322488) (PMCID:PMC10844938)

Abstract

Background There is limited evidence to understand what impact, if any, recovery services might have for patients across the socioeconomic spectrum after critical illness. We analysed data from a multicentre critical care recovery programme to understand the impact of this programme across the socioeconomic spectrum. Methods The setting for this pre-planned secondary analysis was a critical care rehabilitation programme—Intensive Care Syndrome: Promoting Independence and Return to Employment. Data were collected from five hospital sites running this programme. We utilised a Bayesian approach to analysis and explore any possible effect of the InS:PIRE intervention on Health-Related Quality of Life (HRQoL) across the socioeconomic gradient. A Bayesian quantile, non-linear mixed effects regression model, using a compound symmetry covariance structure, accounting for multiple timepoints was utilised. The Scottish Index of Multiple Deprivation (SIMD) was used to measure socioeconomic status and HRQoL was measured using the EQ-5D-5L. Results In the initial baseline cohort of 182 patients, 55% of patients were male, the median age was 58 yr (inter-quartile range: 50–66 yr) and 129 (79%) patients had two or more comorbidities at ICU admission. Using the neutral prior, there was an overall probability of intervention benefit of 100% (β=0.71, 95% credible interval: 0.34–1.09) over 12 months to those in the SIMD≤3 cohort, and an 98.6% (β=−1.38, 95% credible interval: −2.62 to −0.16) probability of greater benefit (i.e. a steeper increase in improvement) at 12 months in the SIMD≤3 vs SIMD≥4 cohort in the EQ-visual analogue scale. Conclusions Using multicentre data, this re-analysis suggests, but does not prove, that an integrated health and social care intervention is likely to improve outcomes across the socioeconomic gradient after critical illness, with a potentially greater benefit for those from deprived communities. Future research designed to prospectively analyse how critical care recovery programmes could potentially improve outcomes across the socioeconomic gradient is warranted.

• Item Type: Articles
• Additional Information: An award from the Health Foundation (173544) and a The Healthcare Improvement Studies Institute (University of Cambridge) Fellowship (307748e01/PD-2019-02-16).
• Keywords: Quality of life, Critical illness, Deprivation, Socioeconomic, Bayesian
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Henderson, Dr Philip and Mactavish, Mrs Pamela and Quasim, Professor Tara and Shaw, Dr Martin
• Authors: McPeake, J., Iwashyna, T. J., Mactavish, P., Devine, H., Henderson, P., Quasim, T., and Shaw, M.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: BJA Open
• Publisher: Elsevier
• ISSN: 2772-6096
• ISSN (Online): 2772-6096
• Copyright Holders: Copyright: © 2024 The Authors
• First Published: First published in BJA Open 9: 100259
• Publisher Policy: Reproduced under a Creative Commons licence

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
173544		Intensive Care Syndrome: Promoting Independence and Return to Employment	Tara Quasim	The Health Foundation (HEALFOU)	Quasim, Dr Tara	SMDN - Anaesthesia