The role of long term acute care hospitals in prolonged mechanical ventilation

长期急症护理医院在延长机械通气方面的作用

• 批准号: 8135941
• 负责人: Jeremy M Kahn
• 金额: $ 35.57万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-01 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8135941
• 关键词: Accounting; Acute; Address; Admission activity; Age; Aging; Beds; Cardiac Surgery procedures; Caring; Case Mixes; Catastrophic Illness; Chronic; Clinical; Clinical effectiveness; Cohort Studies; Congestive Heart Failure; Cost Savings; Critical Care; Critical Illness; Data; Diagnosis; Effectiveness; End stage renal failure; Evaluation; Goals; Health Policy; Health system; Hospital Costs; Hospitals; Incentives; Incidence; Intensive Care; Intensive Care Units; Length of Stay; Life; Long-Term Care; Long-Term Effects; Malignant Neoplasms; Mechanical ventilation; Medicare; Medicare claim; Medicine; Modeling; Myocardial Infarction; Organ failure; Outcome; Patient Care; Patient Transfer; Patients; Penetration; Policies; Policy Maker; Population; Resource Sharing; Resources; Respiratory Failure; Role; Selection Bias; Series; Statistical Models; Stroke; Structure; Subgroup; Survivors; Testing; Time; Trauma; United States; Variant; Weaning; beneficiary; comparative effectiveness; cost; economic impact; financial incentive; high risk; hospital patient care; improved; insight; interest; mortality; public health relevance; trend

DESCRIPTION (provided by applicant): Many patients with critical illness survive the acute episode yet have persistent organ failures requiring ongoing life support and the need for prolonged mechanical ventilation (PMV). PMV is an extraordinarily large financial and clinical burden on the health system-patients with PMV account for nearly half of all intensive care unit costs, and one-year mortality approaches 50%. Traditionally, patients requiring PMV have received their entire episode of acute care within a short stay hospital. However, in recent years there has been a dramatic increase in the use of long-term acute care (LTAC) hospitals for PMV. LTACs are the fastest growing segment of hospital medicine in the United States, increasing at a rate of 12% per year and accounting for $3.1 billion in Medicare spending during 2004 alone. Despite the rapid expansion of the LTAC model for patients with PMV, essential questions remain about their clinical effectiveness and impact on the cost of intensive care. LTACs could be cost-effective model of care for patients with PMV, could raise costs without impacting quality, or may even negatively impact outcomes compared to continued care in a short stay ICU. The overall objective of this application is to study the role of LTACs in the care of critically ill hospitalized patients. We will perform an observational cohort study using national claims data from Medicare beneficiaries and an instrumental variable approach to control for selection bias and unmeasured confounding. In Aim One we will examine the comparative effectiveness of LTACs for patients with PMV, looking at both survival and costs of care. In Aim Two we will determine if the clinical and economic impact of LTACs varies by either patient diagnosis or the type of LTAC--free standing versus vertically integrated (i.e. "hospitals-within-a-hospital"). In Aim Three we will evaluate the broader impact of LTAC penetration on acute care resource utilization and outcome, testing whether variation in LTAC availability and utilization is associated with resource utilization and outcomes for all hospitalized patients. This study will be the first rigorous analysis of LTAC utilization in critically ill patients and will provide key insight into the role of LTACs in the care of patients with respiratory failure and chronic critical illness. PUBLIC HEALTH RELEVANCE: Given the aging of the population and recent advances in critical care, the number of patients requiring PMV will rise in the coming years. Clinicians, policy makers and public have a strong interest in optimizing the structures of care for this high-risk, high-cost population. This project will directly inform key clinical and health policy decisions about long-term acute care hospitals and the care of patients with PMV.

描述（由申请人提供）：许多急性发作的患者幸存下来，但仍有持续的器官失败，需要持续的生命支持以及需要长时间的机械通气（PMV）。 PMV是卫生系统患者的一个非常巨大的财务和临床负担，PMV占所有重症监护病房成本的一半，而一年的死亡率接近50％。传统上，需要PMV的患者在短暂住院医院内收到了整个急诊室。但是，近年来，长期急性护理（LTAC）医院在PMV中的使用急剧增加。 LTAC是美国医院医学增长最快的部分，每年以12％的速度增长，仅2004年就占医疗保险支出的31亿美元。尽管LTAC模型对PMV患者的迅速扩展，但基本问题仍然存在有关其临床效率和对重症监护成本的影响的基本问题。 LTAC可能是针对PMV患者的成本效益的护理模型，可能会提高成本而不会影响质量，甚至可能会对持续护理ICU的持续护理产生负面影响。该应用的总体目的是研究LTAC在重症住院病患者护理中的作用。我们将使用来自Medicare受益人的国家索赔数据以及一种控制选择偏见和未衡量混杂的工具可变方法进行观察队列研究。在AIM ONE中，我们将研究LTAC对PMV患者的比较有效性，从而研究生存和护理成本。在目标二中，我们将确定LTACS的临床和经济影响是否会因患者诊断还是无LTAC的类型（无ltac站立与垂直整合的类型）（即“医院与医院”）。在AIM三中，我们将评估LTAC渗透对急性护理资源利用和结果的更广泛影响，测试LTAC可用性和利用率的变化是否与所有住院患者的资源利用率和结果有关。这项研究将是对危重患者的LTAC利用率的首次严格分析，并将为LTAC在呼吸衰竭和慢性重症疾病患者护理中的作用提供重要的见解。公共卫生相关性：鉴于人口老龄化以及重症监护的最新进展，未来几年需要PMV的患者数量将增加。临床医生，政策制定者和公众对这一高风险，高成本人口的护理结构非常感兴趣。该项目将直接为有关长期急诊医院和PMV患者的护理而直接为关键的临床和健康政策决策提供信息。