Characteristics and health service utilization patterns of ventilator-dependent patients cared for within a vertically integrated health system.
OBJECTIVE
To describe the characteristics and service utilization patterns of long-term ventilator-dependent patients.


METHODS
Using medical records, a cohort of ventilator-dependent patients was identified and followed.


METHODS
A vertically integrated healthcare system in southwestern Pennsylvania.


METHODS
Forty-nine adults requiring prolonged ventilatory assistance.


METHODS
Demographics, admission date, admission diagnosis, discharge diagnosis, reason for ventilator dependency, level of care to which the patient was admitted, dates of all transfer orders, dates of all transfers between levels of care, discharge destination and subsequent readmissions.


RESULTS
The major reason for long-term ventilator dependency was progressive debilitating disease of either a pulmonary or nonpulmonary nature. The mean length of stay within the system was 72.6 days +/- 42.55 (median = 59 days, range = 24 to 267 days). Patients had an average of 3.3 transfers +/- 2.53 within the system (median = 3, range = 0 to 10). No delays in transfer to lower levels of care were found. Health utilization variables were largely unrelated to reason for ventilator dependency. Almost half of the patients (n = 24 or 49.0%) died in the system. Patients who died in the system were significantly older than patients for whom discharge home was possible.


CONCLUSIONS
Additional studies are necessary to describe the prevalence, etiology, health status and functional status of ventilator patients at all levels of care; the impact of different system approaches on patient well-being and cost of care; and the process of medical decision making. Economic analyses of costs and outcomes for ventilator-dependent patients using a cost-utility approach are also needed.
Sevick
M A
MA
Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA 15213.
Zucconi
S
S
Sereika
S
S
Puczynski
S
S
Drury
R
R
Marra
R
R
Mattes
P
P
Taylor
J
J
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006302:Health Services Research; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008134:Long-Term Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009096:Multi-Institutional Systems / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data; D010414:Pennsylvania; D011383:Progressive Patient Care / Q000458:organization & administration*; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D012959:Socioeconomic Factors