nrc

Quality of life ofcritical illness survivors in Sri Lanka- a national study

NRC Grant:  15-114

Dr. A. Pubudu De Silva
National Intensive Care Surveillance
Directorate of Healthcare Quality Secretariat
Castle Street Hospital for Women
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Area of Research:Community Medicine
Status:Ongoing

 

objectives

General:

To assess quality of life of critical illness survivors 3/6 months afterdischarge and to develop and validate a model for predicting prospective quality of life. Specific:

1. To describe the survivalof critically unwell patients 6 months following discharge from the ICU

2. To describe the quality of life among ICU patients 6 months after discharge from the ICU

3. To describe the association of QOL with age, length of ICU stay, severity of illness, admission type, primary diagnosis and gender among ICU patients three months andsix months after discharge from the ICU.

4. To develop and validate a model for predicting prospective quality of life

overview

Severity of illness and socio-economic parameters are beginning to be identified globally as determinants of critical care outcome for ICU patients as well as for the post-ICU quality of life. Predictions of critical care outcome and the post-ICU quality of life based on such factors would enable the health care system to better intervention. Critical care outcomes are affected by severity of illness and are thus used in comparing ICU outcomes. Severity of illness is being accepted as a major factor affecting the quality of life in the “West”. Critical care outcomes are moving from entity of mere “survival” into the concept of “quality of life” (QOL) outcomes such as “Health-related quality of life”, “quality-adjusted survival” and “disability-adjusted survival”.There are also indications that socio economic determinants are of importance in predicting these QOL outcomes in critical care survivors.

Prognostic models use severity of illness to predict critical care outcomes. However, current models of prognostication used in critical care do not include socioeconomic determinants. The economic burden to the individual, family and the state after critical illness is high, and are even more important in resource-limited settings. These implications have not been adequately explored.

We propose an observational analytical study (of 18 months) in all Sri Lankan state Hospitals with ICUs, connected to our national surveillance network (NICS), to determine the association between socioeconomic factors and severity of illness, with outcomes including QOL after critical care.

Interviewer administered questionnaires and data extraction forms will be utilized as study tools. Former would include components of socio-economic parameters and components of SF- 36 and EQ-5D for post-ICU QOL measurements. Severity of illness, diagnosis and ICU outcomes will be extracted from the NICS database after due authorization.

We will also assess the economic impact of post critical care in relation to these determinants. We then propose to develop and validate a model to predict quality of life based on these determinants.

Study findings will enable assistance to be directed to those most needing help, justify and demonstrate the costs of critical care, guide policy decisions and allocation of resources, and produce a model potentially applicable to other settings.