Employment Outcomes after Critical Illness

Abstract

Employment outcomes following hospitalization are essential to assess for working-age patients, as they directly link to a person's functional recovery, social reintegration, and economic status. Research shows that one-third of previously employed intensive care unit (ICU) survivors are jobless for up to 5 years following hospital discharge. Those who return to work (RTW) earn less compared to their pre-illness annual income. Furthermore, there is a marked rise in the need for Medicare and Medicaid as the source of health insurance in this population post-discharge. In the past few decades, several models have been proposed to describe the process and potential factors that influence patients' responses to RTW across various populations, though not specifically for critical illness. Thus, in this dissertation, I proposed a conceptual model of RTW following critical illness based on Bronfenbrenner's ecological model and RTW models for other populations and tested this model using multiple approaches. By using systematic review, meta-analysis, and meta-regression, I revealed that time and level of disability policy support are factors associated with the proportion of ICU survivors who RTW. In subsequent papers, I focused on critically ill patients with acute respiratory distress syndrome (ARDS). By conducting a secondary analysis using data from the ARDS Network Long-Term Outcomes Study (ALTOS) together with the Occupational Information Network (O*NET) system, I reveal that Pre-ARDS workload was not associated with post-ARDS RTW. However, several other factors were found to be negatively associated with RTW. These factors included critical illness characteristics, post-ARDS functional impairment, pain, fatigue, and imbalance in work ability, and not working at prior follow-up time. Using structural equation modeling and mediation analysis, I revealed that disease severity had the most considerable effect on RTW at 6 months, followed by functional abilities. Work at 6 months had the most substantial impact on RTW at 12 months, followed by disease severity and functional abilities at both 6- and 12-months follow-up. Work at 6 months, functional abilities at 6 and 12 months, and pre-ARDS workload are mediators to RTW in the ARDS population and are potentially modifiable. Thus, interventions that address early RTW with adequate work accommodation, improvement in function and symptom management, and workload/work modification reduction could assist ARDS survivors RTW.