Propensity score-matching analyses on the effectiveness of integrated prospective payment program for patients with prolonged mechanical ventilation.

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.

• Authors: Chin-Jung Liu, Pei-Tseng Kung, Chia-Chen Chu, Wen-Yu Chou, Yueh-Hsin Wang, Wen-Chen Tsai
• Journal: Health policy (Amsterdam, Netherlands) (Health Policy) Vol. 122 Issue 9 Pg. 970-976 (Sep 2018) ISSN: 1872-6054 [Electronic] Ireland
• PMID: 30097352 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 Elsevier B.V. All rights reserved.

Topics

• Adolescent
• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Catastrophic Illness
• Comorbidity
• Female
• Humans
• Income
• Length of Stay (statistics & numerical data)
• Male
• Middle Aged
• National Health Programs
• Program Evaluation
• Propensity Score
• Prospective Payment System (statistics & numerical data)
• Respiration, Artificial (economics, mortality)
• Taiwan
• Ventilator Weaning (economics, statistics & numerical data)