title: Experience with a step-down respiratory care center at a tertiary referral medical center in Taiwan.
abstract: OBJECTIVE
  The aim of the study was to describe the outcome of patients after 1 year's implementation of an integrated delivery system for respiratory care mandated by the National Health Insurance Bureau in Taiwan.
  
  
  METHODS
  A retrospective observational study was conducted in a step-down respiratory care center (RCC).
  
  
  METHODS
  Patients included adults receiving prolonged mechanical ventilation (> or =21 days).
  
  
  RESULTS
  A total of 224 cases were available for review; 108 (48.2%) patients were successfully weaned. Those who failed weaning had a longer stay in the intensive care unit and RCC (25.1 vs 20.9 and 31.4 vs 18.6 days, P < .05), but there were no differences in the patients' ages (74.3 vs 70.4 years, P = .17) or the Simplified Acute Physiology Score II (52 vs 46.9, P = .18) before admission to the RCC. After discharge from the RCC, only 4.9% of the patients still on a ventilator were weaned within 1 year. Patients who failed weaning in the RCC had a shorter overall survival (5.2 vs 10.4 months, P < .05) and a lower 1-year survival (23.6% vs 44.6%, P < .05).
  
  
  CONCLUSIONS
  Patients admitted to the RCC were still critically ill. Patients who failed weaning in the RCC had had a longer intensive care unit and RCC stay and a worse outcome after leaving the RCC.
authors.affiliation: Chest Division, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, 104 Taiwan.
authors.forename: Jian
authors.initials: J
authors.lastname: Su
authors.forename: Chang-Yi
authors.initials: CY
authors.lastname: Lin
authors.forename: Pei-Jan
authors.initials: PJ
authors.lastname: Chen
authors.forename: Fung J
authors.initials: FJ
authors.lastname: Lin
authors.forename: Shiow-Kwan
authors.initials: SK
authors.lastname: Chen
authors.forename: Hsu-Tah
authors.initials: HT
authors.lastname: Kuo
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012121:Respiration, Artificial; D012125:Respiratory Center; D012138:Respiratory Therapy; D012189:Retrospective Studies; D013624:Taiwan