Mihaela S Stefan1, Brian H Nathanson2, Aruna Priya3, Penelope S Pekow4, Tara Lagu5, Jay S Steingrub6, Nicholas S Hill7, Robert J Goldberg8, David M Kent9, Peter K Lindenauer5. 1. Center for Quality of Care Research, Baystate Medical Center, Springfield, MA; Division of Hospital Medicine, Baystate Medical Center, Springfield, MA; Department of Medicine, Tufts University School of Medicine, Boston, MA. Electronic address: mihaela.stefan@baystatehealth.org. 2. OptiStatim LLC, Longmeadow, MA. 3. Center for Quality of Care Research, Baystate Medical Center, Springfield, MA. 4. Center for Quality of Care Research, Baystate Medical Center, Springfield, MA; School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, MA. 5. Center for Quality of Care Research, Baystate Medical Center, Springfield, MA; Division of Hospital Medicine, Baystate Medical Center, Springfield, MA; Department of Medicine, Tufts University School of Medicine, Boston, MA. 6. Division of Pulmonary and Critical Care, Baystate Medical Center, Springfield, MA. 7. Division of Pulmonary and Critical Care Medicine, Tufts University School of Medicine, Boston, MA. 8. Department of Quantitative Health Sciences, UMass Medical School, Worcester, MA. 9. Institute for Clinical Research and Health Policy Studies, Tufts University School of Medicine, Boston, MA.
Abstract
BACKGROUND: Limited data are available on the use of noninvasive ventilation in patients with asthma exacerbations. The objective of this study was to characterize hospital patterns of noninvasive ventilation use in patients with asthma and to evaluate the association with the use of invasive mechanical ventilation and case fatality rate. METHODS: This cross-sectional study used an electronic medical record dataset, which includes comprehensive pharmacy and laboratory results from 58 hospitals. Data on 13,558 patients admitted from 2009 to 2012 were analyzed. Initial noninvasive ventilation (NIV) or invasive mechanical ventilation (IMV) was defined as the first ventilation method during hospitalization. Hospital-level risk-standardized rates of NIV among all admissions with asthma were calculated by using a hierarchical regression model. Hospitals were grouped into quartiles of NIV to compare the outcomes. RESULTS: Overall, 90.3% of patients with asthma were not ventilated, 4.0% were ventilated with NIV, and 5.7% were ventilated with IMV. Twenty-two (38%) hospitals did not use NIV for any included admissions. Hospital-level adjusted NIV rates varied considerably (range, 0.4-33.1; median, 5.2%). Hospitals in the highest quartile of NIV did not have lower IMV use (5.4% vs 5.7%), but they did have a small but significantly shorter length of stay. Higher NIV rates were not associated with lower risk-adjusted case fatality rates. CONCLUSIONS: Large variation exists in hospital use of NIV for patients with an acute exacerbation of asthma. Higher hospital rates of NIV use does not seem to be associated with lower IMV rates. These results indicate a need to understand contextual and organizational factors contributing to this variability.
BACKGROUND: Limited data are available on the use of noninvasive ventilation in patients with asthma exacerbations. The objective of this study was to characterize hospital patterns of noninvasive ventilation use in patients with asthma and to evaluate the association with the use of invasive mechanical ventilation and case fatality rate. METHODS: This cross-sectional study used an electronic medical record dataset, which includes comprehensive pharmacy and laboratory results from 58 hospitals. Data on 13,558 patients admitted from 2009 to 2012 were analyzed. Initial noninvasive ventilation (NIV) or invasive mechanical ventilation (IMV) was defined as the first ventilation method during hospitalization. Hospital-level risk-standardized rates of NIV among all admissions with asthma were calculated by using a hierarchical regression model. Hospitals were grouped into quartiles of NIV to compare the outcomes. RESULTS: Overall, 90.3% of patients with asthma were not ventilated, 4.0% were ventilated with NIV, and 5.7% were ventilated with IMV. Twenty-two (38%) hospitals did not use NIV for any included admissions. Hospital-level adjusted NIV rates varied considerably (range, 0.4-33.1; median, 5.2%). Hospitals in the highest quartile of NIV did not have lower IMV use (5.4% vs 5.7%), but they did have a small but significantly shorter length of stay. Higher NIV rates were not associated with lower risk-adjusted case fatality rates. CONCLUSIONS: Large variation exists in hospital use of NIV for patients with an acute exacerbation of asthma. Higher hospital rates of NIV use does not seem to be associated with lower IMV rates. These results indicate a need to understand contextual and organizational factors contributing to this variability.
Authors: Peter K Lindenauer; Mihaela S Stefan; Meng-Shiou Shieh; Penelope S Pekow; Michael B Rothberg; Nicholas S Hill Journal: Ann Am Thorac Soc Date: 2015-03
Authors: Gabriel J Escobar; John D Greene; Peter Scheirer; Marla N Gardner; David Draper; Patricia Kipnis Journal: Med Care Date: 2008-03 Impact factor: 2.983
Authors: Mikhail Kosiborod; Silvio E Inzucchi; Harlan M Krumholz; Frederick A Masoudi; Abhinav Goyal; Lan Xiao; Philip G Jones; Suzanne Fiske; John A Spertus Journal: Arch Intern Med Date: 2009-03-09
Authors: Mihaela S Stefan; Aruna Priya; Penelope S Pekow; Tara Lagu; Jay S Steingrub; Nicholas S Hill; Brian H Nathanson; Peter K Lindenauer Journal: J Crit Care Date: 2017-05-23 Impact factor: 3.425
Authors: Mihaela S Stefan; Brian H Nathanson; Tara Lagu; Aruna Priya; Penelope S Pekow; Jay S Steingrub; Nicholas S Hill; Robert J Goldberg; David M Kent; Peter K Lindenauer Journal: Ann Am Thorac Soc Date: 2016-07
Authors: Mihaela S Stefan; Aruna Priya; Penelope S Pekow; Jay S Steingrub; Nicholas S Hill; Tara Lagu; Karthik Raghunathan; Anusha G Bhat; Peter K Lindenauer Journal: BMC Pulm Med Date: 2021-02-05 Impact factor: 3.317