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Correlation Between Insurance Status and ICU Outcomes in Critically Ill Patients Requiring Percutaneous Tracheotomy Tube Placement FREE TO VIEW

Eric Feucht, MD; Paul Rigby, BSN; Glenn Carlson, ACNP
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Bronson Methodist Hospital, Kalamazoo, MI

Chest. 2013;144(4_MeetingAbstracts):561A. doi:10.1378/chest.1704622
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SESSION TITLE: Outcomes/Quality Control Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: We hypothesize that the admission insurance status of critically ill patients requiring percutaneous tracheostomy tube placement effects patient mortality, hospital length of stay, and hospital costs.

METHODS: We conducted a retrospective cohort study evaluating the relationship between insurance status and hospital outcomes in patients admitted to the Adult Critical Care Service at Bronson Methodist Hospital who underwent percutaneous tracheostomy tube placement for respiratory failure. Patients were included in the study if they underwent a percutaneous tracheostomy tube placement by the critical care service during the time period of January 1, 2007 to December 31, 2010. Patients were divided into four cohorts based on their admission insurances status. The primary end-point of this study was hospital mortality. Secondary outcome end-points were hospital length of stay and hospital costs.

RESULTS: There was no statistical difference in hospital mortality or infectious complications across all insurance types. However, hospital length of stay and total hospital cost were increased in patients with no insurance or Medicaid as compared to commercial or Medicare. Additionally, significantly more Medicare and commercial insurance patients were able to be transferred to a long-term acute care facility (LTAC).

CONCLUSIONS: Patient with Medicaid or no insurance stay in the hospital longer and therefore increase cost to the hospital.

CLINICAL IMPLICATIONS: The patients in this study were unable to be transferred to LTAC or nursing homes because of insurance type and therefore remained in the hospital longer. Limited healthcare resources are being utilized at an increased healthcare cost. Hospitals will continue to need "long-term acute care" beds until changes can be made to entice LTACs, rehab centers and nursing homes to accept these patients.

DISCLOSURE: The following authors have nothing to disclose: Eric Feucht, Paul Rigby, Glenn Carlson

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