Outcomes of prolonged mechanic ventilation: a discrimination model based on longitudinal health insurance and death certificate data
نویسندگان
چکیده
BACKGROUND This study investigated prognosis among patients under prolonged mechanical ventilation (PMV) through exploring the following issues: (1) post-PMV survival rates, (2) factors associated with survival after PMV, and (3) the number of days alive free of hospital stays requiring mechanical ventilation (MV) care after PMV. METHODS This is a retrospective cohort study based on secondary analysis of prospectively collected data in the national health insurance system and governmental data on death registry in Taiwan. It used data for a nationally representative sample of 25,482 patients becoming under PMV (> = 21 days) during 1998-2003. We calculated survival rates for the 4 years after PMV, and adopted logistic regression to construct prediction models for 3-month, 6-month, 1-year, and 2-year survival, with data of 1998-2002 for model estimation and the 2003 data for examination of model performance. We estimated the number of days alive free of hospital stays requiring MV care in the immediate 4-year period after PMV, and contrasted patients who had low survival probability with all PMV patients. RESULTS Among these patients, the 3-month survival rate was 51.4%, and the 1-year survival rate was 31.9%. Common health conditions with significant associations with poor survival included neoplasm, acute and unspecific renal failure, chronic renal failure, non-alcoholic liver disease, shock and septicaemia (odd ratio < 0.7, p < 0.05). During a 4-year follow-up period for patients of year 2003, the mean number of days free of hospital stays requiring MV was 66.0 in those with a predicted 6-month survival rate < 10%, and 111.3 in those with a predicted 2-year survival rate < 10%. In contrast, the mean number of days was 256.9 in the whole sample of patients in 2003. CONCLUSIONS Neoplasm, acute and unspecific renal failure, shock, chronic renal failure, septicemia, and non-alcoholic liver disease are significantly associated with lower survival among PMV patients. Patients with anticipated death in a near future tend to spend most of the rest of their life staying in hospital using MV services. This calls for further research into assessing PMV care need among patients at different prognosis stages of diseases listed above.
منابع مشابه
Designing a Supplementary Health Insurance Model for Iran
Designing a Supplementary Health Insurance Model for Iran Ali Vafaee Najar 1, Elaheh Hooshmand 1, * 1Social Determinates of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Abstract Background: Considering the importance of complementary health insurance and the necessity of designing a supplementary insurance model for the health system of the country, the purpose...
متن کاملThe Economic Burden of Stroke Based on South Korea’s National Health Insurance Claims Database
Background This study was conducted to determine the scale and the nature of the economic burden caused by strokes and to use the results as an evidential source for determining the allocation of South Korea stroke cases in 2015. Methods For research subjects, the study analyzed demographic characteristics and economic burden based on data from national health insurance (NHI) claims for inpat...
متن کاملTilt Table Practice Improved Ventilation in a Patient with Prolonged Artificial Ventilation Support in Intensive Care Unit
Patients who are on prolonged ventilator support in critical care unit present wide variety of complications, which range from reduction in oxygen uptake to various musculoskeletal impair-ments. Early mobilization and rehabilitation are encouraged to manage these complications effectively. Use of tilt table to motivate early mobilization in the intensive care unit for ventilator practices is no...
متن کاملPresenting the Model of Health Outcomes of Diabetic Patients based on Stressful Life Events with the Mediating Role of Diabetes Self-Compassion and Mindfulness
Introduction: Relatively high prevalence of diabetes, high costs of its treatment, disability and death indicate the need for further research to better understand and efforts to reduce psychological problems in people with diabetes. This study was aimed to investigate the mediating role of diabetes self-compassion and mindfulness in the relationship between stressful life events and health out...
متن کاملEvaluation of Pregnancy Outcomes in Pregnant Women with COVID-19 in Qazvin 1399
Background and Objectives: The coronavirus disease 2019 (COVID-19) pandemic has raised concerns about high-risk groups in community. Due to physiologic changes in pregnancy, these women are prone to this infection; therefore, this study was conducted to evaluate Covid-19 infection and pregnancy outcomes in Qazvin Province. Methods: This longitudinal study was done in Qazvin Province from Ma...
متن کامل