Chin-Jung Liu1, Pei-Tseng Kung2, Chia-Chen Chu3, Wen-Yu Chou4, Yueh-Hsin Wang5, Wen-Chen Tsai6. 1. Department of Public Health, China Medical University, Taichung, Taiwan, ROC; Department of Respiratory Therapy, China Medical University Hospital, China Medical University, Taichung, Taiwan, ROC. Electronic address: cjliu@mail.cmu.edu.tw. 2. Department of Healthcare Administration, Asia University, Taichung, Taiwan, ROC; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan, ROC. Electronic address: ptkung@asia.edu.tw. 3. Department of Respiratory Therapy, China Medical University Hospital, China Medical University, Taichung, Taiwan, ROC; Department of Biomedical Engineering, Chung Yuan Christian University, Jhongli, Taiwan, ROC. Electronic address: ccchu1530@gmail.com. 4. Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC. Electronic address: yiterbear@gmail.com. 5. Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC. Electronic address: u9313045@cmu.edu.tw. 6. Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC. Electronic address: wtsai@mail.cmu.edu.tw.
Abstract
OBJECTIVES: An integrated delivery system with a prospective payment program (IPP) for prolonged mechanical ventilation (PMV) was launched by Taiwan's National Health Insurance (NHI) due to the costly and limited ICU resources. This study aimed to analyze the effectiveness of IPP and evaluate the factors associated with successful weaning and survival among patients with PMV. METHODS: Taiwan's NHI Research Database was searched to obtain the data of patients aged ≥17 years who had PMV from 2006 to 2010 (N=50,570). A 1:1 propensity score matching approach was used to compare patients with and without IPP (N=30,576). Cox proportional hazards modeling was used to examine the factors related to successful weaning and survival. RESULTS: The related factors of lower weaning rate in IPP participants (hazard ratio [HR]=0.84), were older age, higher income, catastrophic illness (HR=0.87), and higher comorbidity. The effectiveness of IPP intervention for the PMV patients showed longer days of hospitalization, longer ventilation days, higher survival rate, and higher medical costs (in respiratory care center, respiratory care ward). The 6-month mortality rate was lower (34.0% vs. 32.9%). The death risk of IPP patients compared to those non-IPP patients was lower (HR=0.91, P<0.001). CONCLUSIONS: The policy of IPP for PMV patients showed higher survival rate although it was costly and related to lower weaning rate.
OBJECTIVES: An integrated delivery system with a prospective payment program (IPP) for prolonged mechanical ventilation (PMV) was launched by Taiwan's National Health Insurance (NHI) due to the costly and limited ICU resources. This study aimed to analyze the effectiveness of IPP and evaluate the factors associated with successful weaning and survival among patients with PMV. METHODS: Taiwan's NHI Research Database was searched to obtain the data of patients aged ≥17 years who had PMV from 2006 to 2010 (N=50,570). A 1:1 propensity score matching approach was used to compare patients with and without IPP (N=30,576). Cox proportional hazards modeling was used to examine the factors related to successful weaning and survival. RESULTS: The related factors of lower weaning rate in IPPparticipants (hazard ratio [HR]=0.84), were older age, higher income, catastrophic illness (HR=0.87), and higher comorbidity. The effectiveness of IPP intervention for the PMVpatients showed longer days of hospitalization, longer ventilation days, higher survival rate, and higher medical costs (in respiratory care center, respiratory care ward). The 6-month mortality rate was lower (34.0% vs. 32.9%). The death risk of IPPpatients compared to those non-IPPpatients was lower (HR=0.91, P<0.001). CONCLUSIONS: The policy of IPP for PMVpatients showed higher survival rate although it was costly and related to lower weaning rate.
Keywords:
Health insurance; Integrated delivery system with a prospective payment program (IPP); Prolonged mechanical ventilation (PMV); Survival; Weaning