The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts


Yen-Tang Lin1, Chia-Chen Chu2, Hsiu-Fen Tan1, Jang-Ming Su3

Background: Since 1998 when the Bureau of National Health Insurance (NHI) launched the Integrated Delivery System (IDS) for ventilator-dependent patients in Taiwan. For further control of the medical global budget, NHI adopted co-payment and capitation, and the Respiratory Care Ward (RCW) Quality Assessment and Rating System were started in 2004. In this retrospective longitudinal study, we analyze the outcome of ventilator-dependent patients under the new system.

Methods and Materials: The subjects consisted of 625 patients in RCW of seven regional hospitals in Taiwan from 2005 to 2006. Several variables were assessed on medical records, including ventilator weaning rate, nosocomial infection, ICU readmission rate, and home care referral rate. The Kaplan-Meier method was used for the patients' ventilator weaning and survival curves. The post-admission survival correlation with multiple risk factors was studied by Cox regression analysis.

Results: The 625 patients (M/F= 388/237) aged 72.4±13.8 on average. 47 (7.5%) patients were successfully weaned from ventilator after a mean time of 174±194 days, with a mortality rate of 32.8%. As for the sites of nosocomial infection, the urinary tract infection (UTI) were the mostly common (56%). The patients survival in RCW were 77%, 57%, 45% in 1-, 3-, 5-year survival rate respectively and the median survival time was 4.1 years. Survival analysis of these six different diseases groups in RCW did not reveal any statistically significant difference (Log Rank: 10.79, P=0.056). Cox regression analysis had shown that, there was first statistically significant correlation (P<:0.01) between age and post-admission survival (Hazard Ratio=1.020 times/age-year), second significance (P<:0.05) between presence of the renal disease and post-admission survival (Hazard Ratio=1.719 times) and third significance (P<0.05) between the presence of COPD disease and post-admission survival (Hazard Ratio =0.725 times).

Conclusion: The management goal for long-term ventilator-dependent patients is to prevent UTI. No survival difference is found between the six diseases groups in RCW. Cox regression analysis reveal a significant correlation on the patent' age, and whether the patient suffered from the renal and COPD disease when admitted to RCW (P=0.002, P= 0.013, P= 0.042).