title: Patterns in costs and outcomes for patients with prolonged mechanical ventilation undergoing tracheostomy: an analysis of discharges under diagnosis-related group 483 in New York State from 1992 to 1996.
abstract: OBJECTIVE
  To analyze the costs and discharge status for patients with prolonged mechanical ventilation undergoing tracheostomy.
  
  
  METHODS
  Retrospective analysis of a statewide database.
  
  
  METHODS
  All patients (n = 37,573) >18 yrs of age who had prolonged mechanical ventilation (procedure code 96.72) and were discharged from the hospital between 1992 and 1996 with a final DRG code of 483.
  
  
  METHODS
  None.
  
  
  RESULTS
  Rates of change in discharges and hospital reimbursements and the cost per survivor were examined by case payment groups and discharge year. A direct relation between volume and reimbursement rate was seen over time, although the patient age distributions remained relatively stable. The greatest increase in volume was from 1995 to 1996. For most years, there was a consistent inverse relation between age and survival, with older survivors being more likely to be discharged to residential healthcare facilities and younger patients more likely to be discharged home. There was a consistent direct relation between age and cost per survivor, mainly the result of improved survival rather than decreased reimbursements in later years.
  
  
  CONCLUSIONS
  More controlled reimbursements and improved overall survival rates for DRG 483 have contributed to the improved cost per survivor among all age groups over the period. Given the greater proportion of elderly that do not survive or who are placed into residential healthcare facilities, more scrutiny is needed concerning the use of DRG 483 resources so that care is better coordinated for these patients in the inpatient and postacute care settings.
authors.affiliation: Department of Health Policy, Management and Behavior, State University of New York at Albany, USA. ddewar@cnsvax.albany.edu
authors.forename: D M
authors.initials: DM
authors.lastname: Dewar
authors.forename: C J
authors.initials: CJ
authors.lastname: Kurek
authors.forename: J
authors.initials: J
authors.lastname: Lambrinos
authors.forename: I L
authors.initials: IL
authors.lastname: Cohen
authors.forename: Y
authors.initials: Y
authors.lastname: Zhong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000191:economics; D016208:Databases, Factual; D003953:Diagnosis-Related Groups; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D009518:New York; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000191:economics*; D012189:Retrospective Studies; D016019:Survival Analysis; D014139:Tracheostomy / Q000191:economics*