Dewar DM, Lambrinos J, Cohen IL, Hannan EL; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1997; 14: 174-5.
School of Public Health, State University of New York at Albany, Rensselaer 12144-3456, USA.
RESEARCH OBJECTIVES: The relative risk of mortality among these high-risk/high-cost patients is estimated, and variations in mortality among hospitals are identified. STUDY DESIGN: A logistic regression model is used to determine the relative risk of mortality among prolonged mechanically ventilated patients with tracheostomy due to: patients' clinical, demographic and payer characteristics, and hospital organizational characteristics. This estimation is based on a sample of 27,491 discharged patients classified in DRG#483 (Mechanical Ventilation with Tracheostomy) in all acute care non-Federal hospitals in New York State from 1992 through 1995. PRINCIPAL FINDINGS: Preliminary results show that a combination of high resource use and higher mortality rates exists over time, with a considerable amount of variation across hospitals with respect to mortality rates. These findings hold after controlling for hospital case mix, and accounting for regulatory and market-driven reimbursement methodologies. Further, acute care length of stay and patient age are strong determinants of mortality, where those with longer lengths of stay or who are younger have a lower risk of mortality. CONCLUSIONS: This analysis underscores the impact of variations in hospital practice patterns and resource utilization on mortality. It also provides a foundation to identify strategies to target outlier hospitals in terms of mortality to improve quality of care and resource utilization for this patient subpopulation. This information can be used to track changes in resource utilization as a result of a movement from a regulated to a competitive hospital market. RELEVANCE TO POLICY: Prolonged mechanically ventilated patients capture a large subpopulation of the critically ill and therefore, have the potential of consuming a large share of shrinking health care budgets. With the enactment of market-driven hospital reimbursement policies for a larger share of this patient base, quality measures will become increasingly important in the determination of clinically sound treatment protocols and more cost-effective resource allocation.
Publication Types:
Keywords:
- Critical Illness
- Diagnosis-Related Groups
- Health Resources
- Hospitals
- Humans
- Logistic Models
- New York
- Patient Discharge
- Respiration, Artificial
- Tracheostomy
- economics
- mortality
- surgery
- hsrmtgs
Other ID:
UI: 102233661
From Meeting Abstracts