PURPOSE: Current regulatory payment policy increasingly reflects the assumption that reliable costs and outcomes comparisons for mechanically ventilated patients can be made between short-term acute care (STAC) and long-term acute care (LTAC) settings. This study tested the hypothesis that STAC patients on mechanical ventilation are relatively homogeneous, as determined by discharge ventilation status and discharge destination.
METHODS: Medical records from a university-affiliated tertiary hospital were obtained for every in-patient discharged with ventilator-associated DRG numbers 475, 541, 542 and 565 in 2006 (n=301). Charts were abstracted for length of stay, discharge ventilator status, and discharge disposition, categorized as deceased, formal home health care (HHC), in-patient rehabilitation facility (IRF), skilled nursing facility (SNF), or long term acute care (LTAC) hospital.
RESULTS: The average length of stay was 24 +/- 23 days (range 1–137 days). For all patients, 29% died prior to discharge, and 53% remained on mechanical ventilation. Considerable heterogeneity by discharge destination and ventilator status was seen. Of the 215 patients (71%) that were discharged alive, 46% were discharged to an LTAC; with HHC, SNF, and IRF receiving 21%, 17% and 16% of discharges, respectively. At the time of transfer to LTAC, 21% had weaned. Conversely, patients discharged to IRF, HHC, or to a SNF with a chronic vent unit, had successfully weaned in 94%, 89% and 97% of cases, respectively. For STAC DRG 475 discharges to SNF, IRF, HHC, LTAC and death, wean rates were 100, 93, 85, 37 and 17%, respectively (p<0.0001). Similar patterns were observed when data was stratified by other vent-related DRGs.
CONCLUSION: Mechanically ventilated patients represent a clinically variable group, even within distinct vent-related DRGs. STAC ventilated patients discharged to LTAC are more likely to remain mechanically ventilated and thus more seriously ill and medically complex than those discharged to other post acute locations, where continued mechanical ventilation is rare.
CLINICAL IMPLICATIONS: Stratification by ventilator-related DRGs is inadequate for making valid cost and quality comparisons across care settings for mechanically ventilated patients.
DISCLOSURE: Sean Muldoon, No Product/Research Disclosure Information; Employee SRM is an employee of Kindred Healthcare, a provider of LTAC services. However, he did not perform chart abstracting or data analysis.