Impact of Taiwan's integrated prospective payment program on prolonged mechanical ventilation: a 6-year nationwide study.

OBJECTIVE 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). METHODS 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. RESULTS 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. CONCLUSIONS 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.