Association of Proximity to a Long-Term Acute Care Hospital With Hospital Tracheostomy Practices.
Adult
Aged
Aged, 80 and over
California
Comorbidity
Female
Hospital Mortality
Hospitals
/ statistics & numerical data
Humans
Long-Term Care
/ statistics & numerical data
Male
Middle Aged
Respiration, Artificial
/ statistics & numerical data
Respiratory Insufficiency
/ therapy
Retrospective Studies
Sociodemographic Factors
Tracheostomy
/ statistics & numerical data
Transportation
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
01 01 2022
01 01 2022
Historique:
pubmed:
25
6
2021
medline:
17
2
2022
entrez:
24
6
2021
Statut:
ppublish
Résumé
Availability of long-term acute care hospitals has been associated with hospital discharge practices. It is unclear if long-term acute care hospital availability can influence patient care decisions. We sought to determine the association of long-term acute care hospital availability at different hospitals with the likelihood of tracheostomy. Retrospective cohort study. California Patient Discharge Database, 2016-2018. Adult patients receiving mechanical ventilation for respiratory failure. None. Using the California Patient Discharge Database 2016-2018, we identified all mechanically ventilated patients and those who received tracheostomy. We determine the association between tracheostomy and the distance between each hospital and the nearest long-term acute care hospital and the number of long-term acute care hospital beds within 20 miles of each hospital. Among 281,502 hospitalizations where a patient received mechanical ventilation, 22,899 (8.1%) received a tracheostomy. Patients admitted to a hospital closer to a long-term acute care hospital compared with those furthest from a long-term acute care hospital had 38.9% (95% CI, 33.3-44.6%) higher odds of tracheostomy (closest hospitals 8.7% vs furthest hospitals 6.3%, adjusted odds ratio = 1.65; 95% CI, 1.40-1.95). Patients had a 32.4% (95% CI, 27.6-37.3%) higher risk of tracheostomy when admitted to a hospital with more long-term acute care hospital beds in the immediate vicinity (most long-term acute care hospital beds within 20 miles 8.9% vs fewest long-term acute care hospital beds 6.7%, adjusted odds ratio = 1.54; 95% CI, 1.31-1.80). Distance to the nearest long-term acute care hospital was inversely correlated with hospital risk-adjusted tracheostomy rates (ρ = -0.25; p < 0.0001). The number of long-term acute care hospital beds within 20 miles was positively correlated with hospital risk-adjusted tracheostomy rates (ρ = 0.22; p < 0.0001). Proximity and availability of long-term acute care hospital beds were associated with patient odds of tracheostomy and hospital tracheostomy practices. These findings suggest a hospital effect on tracheostomy decision-making over and above patient case-mix. Future studies focusing on shared decision-making for tracheostomy are needed to ensure goal-concordant care for prolonged mechanical ventilation.
Identifiants
pubmed: 34166292
doi: 10.1097/CCM.0000000000005146
pii: 00003246-202201000-00008
pmc: PMC9078375
mid: NIHMS1701565
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
93-102Subventions
Organisme : NHLBI NIH HHS
ID : K23 HL141704
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL136403
Pays : United States
Organisme : NINR NIH HHS
ID : R01 NR016459
Pays : United States
Informations de copyright
Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
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