Time spent in prior hospital stay and outcomes for ventilator patients in long-term acute care hospitals
Abstract Background Long-term acute care hospitals (LTACHs) treat mechanical ventilator patients who are difficult to wean and expected to be on mechanical ventilator for a prolonged period. However, there are varying views on who should be transferred to LTACHs and when they should be transferred....
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| Format: | Article |
| Language: | English |
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BMC
2021-03-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | https://doi.org/10.1186/s12890-021-01454-1 |
| _version_ | 1828964464587702272 |
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| author | Berna Demiralp Lane Koenig Jing Xu Samuel Soltoff John Votto |
| author_facet | Berna Demiralp Lane Koenig Jing Xu Samuel Soltoff John Votto |
| author_sort | Berna Demiralp |
| collection | DOAJ |
| description | Abstract Background Long-term acute care hospitals (LTACHs) treat mechanical ventilator patients who are difficult to wean and expected to be on mechanical ventilator for a prolonged period. However, there are varying views on who should be transferred to LTACHs and when they should be transferred. The purpose of this study is to assess the relationship between length of stay in a short-term acute care hospital (STACH) after endotracheal intubation (time to LTACH) and weaning success and mortality for ventilated patients discharged to an LTACH. Methods Using 2014–2015 Medicare claims and assessment data, we identified patients who had an endotracheal intubation in STACH and transferred to an LTACH with prolonged mechanical ventilation (defined as 96 or more consecutive hours on a ventilator). We controlled for age, gender, STACH stay procedures and diagnoses, Elixhauser comorbid conditions, and LTACH quality characteristics. We used instrumental variable estimation to account for unobserved patient and provider characteristics. Results The study cohort included 13,622 LTACH cases with median time to LTACH of 18 days. The unadjusted ventilator weaning rate at LTACH was 51.7%, and unadjusted 90-day mortality rate was 43.7%. An additional day spent in STACH after intubation is associated with 11.6% reduction in the odds of weaning, representing a 2.5 percentage point reduction in weaning rate at 18 days post endotracheal intubation. We found no statistically significant relationship between time to LTACH and the odds of 90-day mortality. Conclusions Discharging ventilated patients earlier from STACH to LTACH is associated with higher weaning probability for LTACH patients on prolonged mechanical ventilation. Our findings suggest that delaying ventilated patients’ discharge to LTACH may negatively influence the patients’ chances of being weaned from the ventilator. |
| first_indexed | 2024-12-14T10:50:23Z |
| format | Article |
| id | doaj.art-7c9dc590eb2f40988a0434c961e80fc8 |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-12-14T10:50:23Z |
| publishDate | 2021-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-7c9dc590eb2f40988a0434c961e80fc82022-12-21T23:05:16ZengBMCBMC Pulmonary Medicine1471-24662021-03-012111910.1186/s12890-021-01454-1Time spent in prior hospital stay and outcomes for ventilator patients in long-term acute care hospitalsBerna Demiralp0Lane Koenig1Jing Xu2Samuel Soltoff3John Votto4KNG Health Consulting, LLCKNG Health Consulting, LLCKNG Health Consulting, LLCKNG Health Consulting, LLCHospital for Special CareAbstract Background Long-term acute care hospitals (LTACHs) treat mechanical ventilator patients who are difficult to wean and expected to be on mechanical ventilator for a prolonged period. However, there are varying views on who should be transferred to LTACHs and when they should be transferred. The purpose of this study is to assess the relationship between length of stay in a short-term acute care hospital (STACH) after endotracheal intubation (time to LTACH) and weaning success and mortality for ventilated patients discharged to an LTACH. Methods Using 2014–2015 Medicare claims and assessment data, we identified patients who had an endotracheal intubation in STACH and transferred to an LTACH with prolonged mechanical ventilation (defined as 96 or more consecutive hours on a ventilator). We controlled for age, gender, STACH stay procedures and diagnoses, Elixhauser comorbid conditions, and LTACH quality characteristics. We used instrumental variable estimation to account for unobserved patient and provider characteristics. Results The study cohort included 13,622 LTACH cases with median time to LTACH of 18 days. The unadjusted ventilator weaning rate at LTACH was 51.7%, and unadjusted 90-day mortality rate was 43.7%. An additional day spent in STACH after intubation is associated with 11.6% reduction in the odds of weaning, representing a 2.5 percentage point reduction in weaning rate at 18 days post endotracheal intubation. We found no statistically significant relationship between time to LTACH and the odds of 90-day mortality. Conclusions Discharging ventilated patients earlier from STACH to LTACH is associated with higher weaning probability for LTACH patients on prolonged mechanical ventilation. Our findings suggest that delaying ventilated patients’ discharge to LTACH may negatively influence the patients’ chances of being weaned from the ventilator.https://doi.org/10.1186/s12890-021-01454-1Ventilator weaningMortalityLength of stay |
| spellingShingle | Berna Demiralp Lane Koenig Jing Xu Samuel Soltoff John Votto Time spent in prior hospital stay and outcomes for ventilator patients in long-term acute care hospitals BMC Pulmonary Medicine Ventilator weaning Mortality Length of stay |
| title | Time spent in prior hospital stay and outcomes for ventilator patients in long-term acute care hospitals |
| title_full | Time spent in prior hospital stay and outcomes for ventilator patients in long-term acute care hospitals |
| title_fullStr | Time spent in prior hospital stay and outcomes for ventilator patients in long-term acute care hospitals |
| title_full_unstemmed | Time spent in prior hospital stay and outcomes for ventilator patients in long-term acute care hospitals |
| title_short | Time spent in prior hospital stay and outcomes for ventilator patients in long-term acute care hospitals |
| title_sort | time spent in prior hospital stay and outcomes for ventilator patients in long term acute care hospitals |
| topic | Ventilator weaning Mortality Length of stay |
| url | https://doi.org/10.1186/s12890-021-01454-1 |
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