Trend Analysis of Hospital Resource Utilization for Prolonged Mechanical Ventilation Patients in Taiwan: A Population-Based Study

Hung, Tien-Chiung; Lai, Yung-Fa; Tseng, Chun-Chieh; Hong, Yong‐Han; Shi, Hon-Yi

doi:10.4187/respcare.01519

Cited by 18 publications

(16 citation statements)

References 24 publications

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“…The convenience and accessibility of the Taiwan national health insurance system may increase the likelihood of treatment for MV patients [ 1 , 2 ]. Improved medical techniques may also increase the number of patients with co-morbidities who are willing to receive invasive MV [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Mechanical ventilation (MV) is among the most common therapeutic interventions in intensive care units (ICUs), and the use of MV tends to be highest in developed countries [ 1 ]. As economic conditions increase pressure to improve efficiency in medical resource utilization, hospitals have begun transferring patients who require MV but who are hemodynamically stable from ICUs into other hospital wards or other facilities [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Trend Analysis and Outcome Prediction in Mechanically Ventilated Patients: A Nationwide Population-Based Study in Taiwan

et al. 2015

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ObjectiveTo investigate the relationship between changes in patient attributes and hospital attributes over time and to explore predictors of medical utilization and mortality rates in mechanical ventilation (MV) patients in Taiwan.BackgroundProviding effective medical care for MV patients is challenging and requires good planning and effective clinical decision making policies. Most studies of MV, however, have only analyzed a single regional ventilator weaning center or respiratory care unit, high-quality population-based studies of MV trends and outcomes are scarce.MethodsThis population-based cohort study retrospectively analyzed 213,945 MV patients treated during 2004-2009.ResultsDuring the study period, the percentages of MV patients with the following characteristics significantly increased: age ≦ 65 years, treatment at a medical center, and treatment by a high-volume physician. In contrast, the percentages of MV patients treated at local hospitals and by low-volume physicians significantly decreased (P<0.001). Age, gender, Deyo-Charlson co-morbidity index, teaching hospital, hospital level, hospital volume, and physician volume were significantly associated with MV outcome (P<0.001). Over the 6-year period analyzed in this study, the estimated mean hospital treatment cost increased 48.8% whereas mean length of stay decreased 13.9%. The estimated mean overall survival time for MV patients was 16.4 months (SD 0.4 months), and the overall in-hospital 1-, 3-, and 5-year survival rates were 61.0%, 36.7%, 17.3%, and 9.6%, respectively.ConclusionsThese population-based data revealed increases in the percentages of MV patients treated at medical centers and by high-volume physicians, especially in younger patients. Notably, although LOS for MV patients decreased, hospital treatment costs increased. Healthcare providers and patients should recognize that attributes of both the patient and the hospital may affect outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Trend Analysis and Outcome Prediction in Mechanically Ventilated Patients: A Nationwide Population-Based Study in Taiwan

et al. 2015

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“…2 While PMV incidence was 6.3 per 100 ventilated ICU admissions from 2002 to 2006 in the United Kingdom, 3 in Taiwan, the PMV rate fell from 94.3 to 89.38 per 100,000 persons from 2004 to 2007. 4 In the United States, a population-based study found that the incidence of tracheostomy for PMV was 24.2 per 100,000 people in 2002, and this rate had increased by nearly 200% from the previous decade. 5 Zilberberg and colleagues estimated that, based on growth trends between 1993 and 2005, the number of patients receiving PMV is expected to double between 2000 and 2020, from 252,577 to 605,898.…”

Section: Introductionmentioning

confidence: 99%

“…8 This prolonged care also accounts for 29.1% of the general ICU bed days. 4 In 2005, Medicare-eligible patients who required PMV ranked third in summative in-patient charges by diagnostic groups and first in charges per patient. 9 Despite receiving such a high level of care, 29 -49% of PMV patients died in the hospital, 10,11 only 19% could be discharged home, 10 and Ͻ50% of PMV hospital survivors survived more than 1 y.…”

Section: Introductionmentioning

confidence: 99%

Survey of Prolonged Mechanical Ventilation in Intensive Care Units in Mainland China

Zhan

Wang

2016

Respir Care

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INTRODUCTION:In mainland China, there are no special care centers (long-term acute care, weaning, chronic care facilities) for patients requiring prolonged mechanical ventilation (PMV). Our goal was to characterize the prevalence and outcome of patients undergoing PMV in Chinese intensive care units (ICUs). METHODS: A prospective 1-d prevalence study was performed at 55 ICUs, with 28-d follow-up. RESULTS: On the observation day, 622 adult patients occupied ICU beds. Enrollment criteria were met by 302 subjects receiving invasive mechanical ventilation, of which 109 (36.1%) had received ventilation for more than 21 d (median 51, 21-3,419), which was defined as PMV. During the following 28 d, another 45 subjects were classified as receiving PMV, but only 5% (3/58) of the subjects who were newly admitted to the ICU on the study day received PMV. Thirty-six (22.9%) of the 157 subjects receiving PMV were weaned, and 81 (51.6%) continued ventilation in the ICU. In the logistic regression analysis, age >74 y (odds ratio ‫؍‬ 2.78, 95% CI 1.05-7.40, P ‫؍‬ .041) and chronic congestive heart failure (odds ratio ‫,32.21؍‬ 95% CI 1.48 -101.05, P ‫؍‬ .020) were associated with failure to wean in 28 d, while acute respiratory distress syndrome (ARDS) as the reason for mechanical ventilation (odds ratio ‫؍‬ 0.14, 95% CI 0.04 -0.52, P ‫؍‬ .003) was associated with successful weaning. CONCLUSION: The number of subjects receiving PMV was surprisingly high in this cross-section of Chinese ICUs. In the following 28 ICU days, only a small proportion of these subjects were weaned. Age and chronic heart dysfunction were high risk factors for weaning failure.

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“…The initial phase was defined as the first 12 months after a cancer diagnosis. Additionally, other Taiwan studies of care costs have similarly used reimbursement, rather than charges, as a proxy for medical care costs because the NHI charge for a service is not necessarily related to the actual cost of providing the service [9] – [11] . In contrast, NHI costs, which are typically defined as actual payments derived from reimbursement formulas, are used to reflect the average resource utilization for a health service [11] , [12] .…”

Section: Methodsmentioning

confidence: 99%

Cost Trend Analysis of Initial Cancer Treatment in Taiwan

Hsieh

Lee

et al. 2014

PLoS ONE

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BackgroundDespite the high cost of initial cancer care, that is, care in the first year after diagnosis, limited information is available for specific categories of cancer-related costs, especially costs for specific services. This study purposed to identify causes of change in cancer treatment costs over time and to perform trend analyses of the percentage of cancer patients who had received a specific treatment type and the mean cost of care for patients who had received that treatment.Methodology/Principal FindingsThe analysis of trends in initial treatment costs focused on cancer-related surgery, chemotherapy, radiation therapy, and treatments other than active treatments. For each cancer-specific trend, slopes were calculated for regression models with 95% confidence intervals. Analyses of patients diagnosed in 2007 showed that the National Health Insurance (NHI) system paid, on average, $10,780 for initial care of a gastric cancer patient and $10,681 for initial care of a lung cancer patient, which were inflation-adjusted increases of $6,234 and $5,522, respectively, over the 1996 care costs. During the same interval, the mean NHI payment for initial care for the five specific cancers increased significantly (p<0.05). Hospitalization costs comprised the largest portion of payments for all cancers. During 1996–2007, the use of chemotherapy and radiation therapy significantly increased in all cancer types (p<0.05). In 2007, NHI payments for initial care for these five cancers exceeded $12 billion, and gastric and lung cancers accounted for the largest share.Conclusions/SignificanceIn addition to the growing number of NHI beneficiaries with cancer, treatment costs and the percentage of patients who undergo treatment are growing. Therefore, the NHI must accurately predict the economic burden of new chemotherapy agents and radiation therapies and may need to develop programs for stratifying patients according to their potential benefit from these expensive treatments.

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Trend Analysis of Hospital Resource Utilization for Prolonged Mechanical Ventilation Patients in Taiwan: A Population-Based Study

Cited by 18 publications

References 24 publications

Trend Analysis and Outcome Prediction in Mechanically Ventilated Patients: A Nationwide Population-Based Study in Taiwan

Trend Analysis and Outcome Prediction in Mechanically Ventilated Patients: A Nationwide Population-Based Study in Taiwan

Survey of Prolonged Mechanical Ventilation in Intensive Care Units in Mainland China

Cost Trend Analysis of Initial Cancer Treatment in Taiwan

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