Impact of Taiwan's integrated prospective payment program on prolonged mechanical ventilation: a 6-year nationwide study
The integrated prospective payment program (IPP), which encourages the integrated care of mechanically ventilated patients in order to reduce the heavy utilization of high-cost ICUs, has been implemented by Taiwan's Bureau of National Health Insurance since July 2000. The aim of this study was...
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| Veröffentlicht in: | Respiratory care 2013-04, Vol.58 (4), p.676-682 |
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| container_title | Respiratory care |
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| creator | Liu, Chin-Jung Chu, Chia-Chen Chen, Wei Cheng, Wei-Erh Shih, Chuen-Ming Tsai, Yuh-Show Muo, Chih-Hsin Chen, Pei-Chun |
| description | The integrated prospective payment program (IPP), which encourages the integrated care of mechanically ventilated patients in order to reduce the heavy utilization of high-cost ICUs, has been implemented by Taiwan's Bureau of National Health Insurance since July 2000. The aim of this study was to assess the impact of this program on weaning, hospital stay, mortality, and cost for patients requiring prolonged mechanical ventilation (PMV).
A data set of 1,000,000 randomly selected insurance holders from the National Health Research Insurance Database, Taiwan, was retrospectively analyzed. We enrolled 7,967 adult patients (age ≥ 17 y) who required PMV (duration ≥ 21 d) over a 6 year period.
There were 3,275 patients on PMV before (1997-1999) and 4,692 patients on PMV after (2001-2003) the IPP implementation. After IPP implementation, PMV was found to be required in patients with a significantly higher age, lower urbanization level, higher income status, and a higher prevalence of neuromuscular disease (P < .001). In-hospital mortality was similar between the 2 periods (17.2% before vs 16.2% after, P = .26), but the weaning rate was significantly lower in the latter period (68.1% vs 64.2%, P < .001). Total hospital stay (75.3 d vs 95.1 d, P < .001) and duration of mechanical ventilation usage (55.8 d vs 71.6 d, P < .001) were both significantly higher after the IPP implementation. Total hospitalization cost in the PMV patients was significantly lower after IPP implementation.
Implementation of the IPP program reduced the total hospitalization cost, increased the duration of mechanical ventilation usage and stay, and reduced the weaning rate in PMV patients. |
| doi_str_mv | 10.4187/respcare.01242 |
| format | Article |
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A data set of 1,000,000 randomly selected insurance holders from the National Health Research Insurance Database, Taiwan, was retrospectively analyzed. We enrolled 7,967 adult patients (age ≥ 17 y) who required PMV (duration ≥ 21 d) over a 6 year period.
There were 3,275 patients on PMV before (1997-1999) and 4,692 patients on PMV after (2001-2003) the IPP implementation. After IPP implementation, PMV was found to be required in patients with a significantly higher age, lower urbanization level, higher income status, and a higher prevalence of neuromuscular disease (P < .001). In-hospital mortality was similar between the 2 periods (17.2% before vs 16.2% after, P = .26), but the weaning rate was significantly lower in the latter period (68.1% vs 64.2%, P < .001). Total hospital stay (75.3 d vs 95.1 d, P < .001) and duration of mechanical ventilation usage (55.8 d vs 71.6 d, P < .001) were both significantly higher after the IPP implementation. Total hospitalization cost in the PMV patients was significantly lower after IPP implementation.
Implementation of the IPP program reduced the total hospitalization cost, increased the duration of mechanical ventilation usage and stay, and reduced the weaning rate in PMV patients.</description><identifier>ISSN: 0020-1324</identifier><identifier>EISSN: 1943-3654</identifier><identifier>DOI: 10.4187/respcare.01242</identifier><identifier>PMID: 23050858</identifier><language>eng</language><publisher>United States: Daedalus Enterprises, Inc</publisher><subject>Adult ; Age Factors ; Aged ; Aged, 80 and over ; Artificial respiration ; Critical Care - organization & administration ; Economic aspects ; Female ; Forecasts and trends ; Health Care Costs ; Hospital Mortality ; Humans ; Influence ; Length of Stay ; Male ; Middle Aged ; Prospective Payment System ; Prospective payment systems (Medical care) ; Respiration, Artificial - economics ; Respiration, Artificial - mortality ; Respiration, Artificial - statistics & numerical data ; Retrospective Studies ; Socioeconomic Factors ; Taiwan ; Time Factors</subject><ispartof>Respiratory care, 2013-04, Vol.58 (4), p.676-682</ispartof><rights>COPYRIGHT 2013 Daedalus Enterprises, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c393t-9c6db88a9e49541f9d78e557be1b3d24dd9d0e39ad5401e6c097f4b06cbbfc983</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27922,27923</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23050858$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Liu, Chin-Jung</creatorcontrib><creatorcontrib>Chu, Chia-Chen</creatorcontrib><creatorcontrib>Chen, Wei</creatorcontrib><creatorcontrib>Cheng, Wei-Erh</creatorcontrib><creatorcontrib>Shih, Chuen-Ming</creatorcontrib><creatorcontrib>Tsai, Yuh-Show</creatorcontrib><creatorcontrib>Muo, Chih-Hsin</creatorcontrib><creatorcontrib>Chen, Pei-Chun</creatorcontrib><title>Impact of Taiwan's integrated prospective payment program on prolonged mechanical ventilation: a 6-year nationwide study</title><title>Respiratory care</title><addtitle>Respir Care</addtitle><description>The integrated prospective payment program (IPP), which encourages the integrated care of mechanically ventilated patients in order to reduce the heavy utilization of high-cost ICUs, has been implemented by Taiwan's Bureau of National Health Insurance since July 2000. The aim of this study was to assess the impact of this program on weaning, hospital stay, mortality, and cost for patients requiring prolonged mechanical ventilation (PMV).
A data set of 1,000,000 randomly selected insurance holders from the National Health Research Insurance Database, Taiwan, was retrospectively analyzed. We enrolled 7,967 adult patients (age ≥ 17 y) who required PMV (duration ≥ 21 d) over a 6 year period.
There were 3,275 patients on PMV before (1997-1999) and 4,692 patients on PMV after (2001-2003) the IPP implementation. After IPP implementation, PMV was found to be required in patients with a significantly higher age, lower urbanization level, higher income status, and a higher prevalence of neuromuscular disease (P < .001). In-hospital mortality was similar between the 2 periods (17.2% before vs 16.2% after, P = .26), but the weaning rate was significantly lower in the latter period (68.1% vs 64.2%, P < .001). Total hospital stay (75.3 d vs 95.1 d, P < .001) and duration of mechanical ventilation usage (55.8 d vs 71.6 d, P < .001) were both significantly higher after the IPP implementation. Total hospitalization cost in the PMV patients was significantly lower after IPP implementation.
Implementation of the IPP program reduced the total hospitalization cost, increased the duration of mechanical ventilation usage and stay, and reduced the weaning rate in PMV patients.</description><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Artificial respiration</subject><subject>Critical Care - organization & administration</subject><subject>Economic aspects</subject><subject>Female</subject><subject>Forecasts and trends</subject><subject>Health Care Costs</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Influence</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prospective Payment System</subject><subject>Prospective payment systems (Medical care)</subject><subject>Respiration, Artificial - economics</subject><subject>Respiration, Artificial - mortality</subject><subject>Respiration, Artificial - statistics & numerical data</subject><subject>Retrospective Studies</subject><subject>Socioeconomic Factors</subject><subject>Taiwan</subject><subject>Time Factors</subject><issn>0020-1324</issn><issn>1943-3654</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptkc1v3CAQxVHVqtmmvfZYIVVKe_EWDNimtyjqR6RIuSRnNIbxLpWNXYOT7n8fnI-qlSIOMI_fG8E8Qt5ztpW8qb_MGCcLM24ZL2X5gmy4lqIQlZIvyYaxkhVclPKIvInxVy4rqfRrclQKplijmg35cz5MYBMdO3oF_hbCp0h9SLibIaGj0zzGCW3yN0gnOAwY0qrl24GOYT32Y9hlcEC7h-At9PQmQ76H5MfwlQKtigPCTMO9cOsd0pgWd3hLXnXQR3z3uB-T6-_frs5-FheXP87PTi8KK7RIhbaVa5sGNEqtJO-0qxtUqm6Rt8KV0jntGAoNTknGsbJM151sWWXbtrO6Ecfk80Pf_NbfC8ZkBh8t9j0EHJdouORaSFY3KqMfH9Ad9Gh86MY0g11xcyo0z6OTsszU9hkqL4eDt2PAzmf9P8PJP4Y9Qp_2ceyXdR7x2c42Tz3O2Jlp9gPMB8OZWdM2T2mb-7Sz4cPj35Z2QPcXf4pX3AHFc6fA</recordid><startdate>201304</startdate><enddate>201304</enddate><creator>Liu, Chin-Jung</creator><creator>Chu, Chia-Chen</creator><creator>Chen, Wei</creator><creator>Cheng, Wei-Erh</creator><creator>Shih, Chuen-Ming</creator><creator>Tsai, Yuh-Show</creator><creator>Muo, Chih-Hsin</creator><creator>Chen, Pei-Chun</creator><general>Daedalus Enterprises, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201304</creationdate><title>Impact of Taiwan's integrated prospective payment program on prolonged mechanical ventilation: a 6-year nationwide study</title><author>Liu, Chin-Jung ; Chu, Chia-Chen ; Chen, Wei ; Cheng, Wei-Erh ; Shih, Chuen-Ming ; Tsai, Yuh-Show ; Muo, Chih-Hsin ; Chen, Pei-Chun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c393t-9c6db88a9e49541f9d78e557be1b3d24dd9d0e39ad5401e6c097f4b06cbbfc983</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Artificial respiration</topic><topic>Critical Care - organization & administration</topic><topic>Economic aspects</topic><topic>Female</topic><topic>Forecasts and trends</topic><topic>Health Care Costs</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Influence</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prospective Payment System</topic><topic>Prospective payment systems (Medical care)</topic><topic>Respiration, Artificial - economics</topic><topic>Respiration, Artificial - mortality</topic><topic>Respiration, Artificial - statistics & numerical data</topic><topic>Retrospective Studies</topic><topic>Socioeconomic Factors</topic><topic>Taiwan</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Liu, Chin-Jung</creatorcontrib><creatorcontrib>Chu, Chia-Chen</creatorcontrib><creatorcontrib>Chen, Wei</creatorcontrib><creatorcontrib>Cheng, Wei-Erh</creatorcontrib><creatorcontrib>Shih, Chuen-Ming</creatorcontrib><creatorcontrib>Tsai, Yuh-Show</creatorcontrib><creatorcontrib>Muo, Chih-Hsin</creatorcontrib><creatorcontrib>Chen, Pei-Chun</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Respiratory care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Liu, Chin-Jung</au><au>Chu, Chia-Chen</au><au>Chen, Wei</au><au>Cheng, Wei-Erh</au><au>Shih, Chuen-Ming</au><au>Tsai, Yuh-Show</au><au>Muo, Chih-Hsin</au><au>Chen, Pei-Chun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Taiwan's integrated prospective payment program on prolonged mechanical ventilation: a 6-year nationwide study</atitle><jtitle>Respiratory care</jtitle><addtitle>Respir Care</addtitle><date>2013-04</date><risdate>2013</risdate><volume>58</volume><issue>4</issue><spage>676</spage><epage>682</epage><pages>676-682</pages><issn>0020-1324</issn><eissn>1943-3654</eissn><abstract>The integrated prospective payment program (IPP), which encourages the integrated care of mechanically ventilated patients in order to reduce the heavy utilization of high-cost ICUs, has been implemented by Taiwan's Bureau of National Health Insurance since July 2000. The aim of this study was to assess the impact of this program on weaning, hospital stay, mortality, and cost for patients requiring prolonged mechanical ventilation (PMV).
A data set of 1,000,000 randomly selected insurance holders from the National Health Research Insurance Database, Taiwan, was retrospectively analyzed. We enrolled 7,967 adult patients (age ≥ 17 y) who required PMV (duration ≥ 21 d) over a 6 year period.
There were 3,275 patients on PMV before (1997-1999) and 4,692 patients on PMV after (2001-2003) the IPP implementation. After IPP implementation, PMV was found to be required in patients with a significantly higher age, lower urbanization level, higher income status, and a higher prevalence of neuromuscular disease (P < .001). In-hospital mortality was similar between the 2 periods (17.2% before vs 16.2% after, P = .26), but the weaning rate was significantly lower in the latter period (68.1% vs 64.2%, P < .001). Total hospital stay (75.3 d vs 95.1 d, P < .001) and duration of mechanical ventilation usage (55.8 d vs 71.6 d, P < .001) were both significantly higher after the IPP implementation. Total hospitalization cost in the PMV patients was significantly lower after IPP implementation.
Implementation of the IPP program reduced the total hospitalization cost, increased the duration of mechanical ventilation usage and stay, and reduced the weaning rate in PMV patients.</abstract><cop>United States</cop><pub>Daedalus Enterprises, Inc</pub><pmid>23050858</pmid><doi>10.4187/respcare.01242</doi><tpages>7</tpages></addata></record> |
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| subjects | Adult Age Factors Aged Aged, 80 and over Artificial respiration Critical Care - organization & administration Economic aspects Female Forecasts and trends Health Care Costs Hospital Mortality Humans Influence Length of Stay Male Middle Aged Prospective Payment System Prospective payment systems (Medical care) Respiration, Artificial - economics Respiration, Artificial - mortality Respiration, Artificial - statistics & numerical data Retrospective Studies Socioeconomic Factors Taiwan Time Factors |
| title | Impact of Taiwan's integrated prospective payment program on prolonged mechanical ventilation: a 6-year nationwide study |
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