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Variation in mortality rates after admission to long-term acute care hospitals for ventilator weaning.

Abstract：

PURPOSE:We sought to examine variation in long-term acute care hospital (LTACH) quality based on 90-day in-hospital mortality for patients admitted for weaning from mechanical ventilation. METHODS:We developed an administrative risk-adjustment model using data from Medicare claims. We validated the administrative model against a clinical model using data from LTACHs participating in a 2002 to 2003 clinical registry. We then used our validated administrative model to assess national variation in 90-day in-hospital mortality rates in LTACHs from 2013. RESULTS:The administrative risk-adjustment model was derived using data from 9447 patients admitted to 221 LTACHs in 2003. The model had good discrimination (C statistic=0.72) and calibration. Compared to a clinically derived model using data from 1163 patients admitted to 14 LTACHs, the administrative model generated similar performance estimates. National variation in risk-adjusted mortality was assessed using data from 20,453 patients admitted to 380 LTACHs in 2013. LTACH-specific risk-adjusted mortality rates varied from 8.4% to 48.1% (median: 24.2%, interquartile range: 19.7%-30.7%). CONCLUSIONS:LTACHs vary widely in mortality rates, underscoring the need to better understand the sources of this variation and improve the quality of care for patients requiring long-term ventilator weaning.

journal_name

J Crit Care

journal_title

Journal of critical care

authors

Kahn JM,Davis BS,Le TQ,Yabes JG,Chang CH,Angus DC

doi

10.1016/j.jcrc.2018.03.022

subject

Has Abstract

pub_date

2018-08-01 00:00:00

pages

6-12

eissn

0883-9441

issn

1557-8615

pii

S0883-9441(17)31765-3

journal_volume

46

pub_type

杂志文章,多中心研究

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