The effect of different interventions on the medical quality of prolonged mechanical ventilator

Due to the improvement of health care services and life longevity, the population of prolonged mechanical ventilators has been increased significantly in the past decade. The department of health in Taiwan has conducted an integrated delivery project for care of long-term mechanical ventilators (LMV) in 2000. Meanwhile, the utility of ventilator care has been increasing as the facilities of respiratory care center (RCC), respiratory care ward (RCW), and home care were spending. Therefore, the issues of medical quality and cost containments under different care plans became an important topic for researches. The study aims to investigate the association between physician intervention plans and patients’ medical quality and medical consumption among long-term mechanical ventilators in a medical center. The study is a longitudinal retrospective data analysis, which collected medical information from a respiratory care unit in a medical center of northern Taiwan during 2004-2008. A total of 396 study subjects were recruited from patients with major diagnosis of neurological and cardiovascular diseases who were depending on ventilator for at least 7 days in RCC. The primary study groups were classified by the intervention plans under three consecutive stages in this hospital. Intervention models were designed by the shift pattern of physicians, which were found as long-term continuum care (physicians in charge a patient for over three months), intermediate continuum care (physicians in charge a patient for 1-3 months), and cross-shifting care (physicians cross over every day). The patient prognoses and medical consumptions were compared among these three intervention stages. The study has demonstrated that factors associated with weaning were patient’s diastolic blood pressure, physician’s consulting behavior for treatment decisions, and a clearly set primary treatment goal by the team. The patients’ age was found as a significant factor positively associated with hospitalization days in RCC, long term medical consumptions, death rate during the study period of 2004-2008. APACHE II was positively associated with the likelihood of death in both RCC and overall hospital stay. As a primary result, the long-term continuum care was found as the best model for LMV patient care with lowest death rate and the highest weaning rate. The study has demonstrated that pattern of physician’s intervention significantly affects medical quality and medical consumptions of LMV care. The findings of this study provide valuable information for future policy making on physician intervention models and on-job trainings of professional specialty.

Project ID:PG9909-0038
External Project ID:DOH99-TD-PH-13