Outcomes and Resource Use Associated With Acute Respiratory Failure in Safety Net Hospitals Across the United States
| Autor: | Rhea Rahimtoola, Matthew Gandjian, Joseph Hadaya, Arjun Verma, Catherine G. Williamson, Peyman Benharash, Ava Mandelbaum |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty medicine.medical_treatment Safety net Critical Care and Intensive Care Medicine 03 medical and health sciences 0302 clinical medicine medicine Humans Acute respiratory failure Hospital Mortality 030212 general & internal medicine Hospital Costs Aged Retrospective Studies Mechanical ventilation Medicaid business.industry Retrospective cohort study United States 030228 respiratory system Respiratory failure Strictly standardized mean difference Acute Disease Emergency medicine Health Resources Female Health care reform Respiratory Insufficiency Cardiology and Cardiovascular Medicine business Safety-net Providers Follow-Up Studies |
| Zdroj: | Chest. 160:165-174 |
| ISSN: | 0012-3692 |
| DOI: | 10.1016/j.chest.2021.02.018 |
| Popis: | Despite the frequency and cost of hospitalizations for acute respiratory failure (ARF), the literature regarding the impact of hospital safety net burden on outcomes of these hospitalizations is sparse.How does safety net burden impact outcomes of ARF hospitalizations such as mortality, tracheostomy, and resource use?This was a retrospective cohort study using the National Inpatient Sample 2007-2017. All patients hospitalized with a primary diagnosis of ARF were tabulated using the International Classification of Diseases 9th and 10th Revision codes, and safety net burden was calculated using previously published methodology. High- and low-burden hospitals were generated from proportions of Medicaid and uninsured patients. Trends were analyzed using a nonparametric rank-based test, whereas multivariate logistic and linear regression models were used to establish associations of safety net burden with key clinical outcomes.Of an estimated 8,941,334 hospitalizations with a primary diagnosis of ARF, 33.9% were categorized as occurring at low-burden hospitals (LBHs) and 31.6% were categorized as occurring at high-burden hospitals (HBHs). In-hospital mortality significantly decreased at HBHs (22.8%-12.6%; nonparametric trend [nptrend] .001) and LBHs (22.0%-10.9%; nptrend .001) over the study period, as did tracheostomy placement (HBH, 5.6%-1.3%; LBH, 3.5%-0.8%; all nptrend .001). After adjustment for patient and hospital factors, an HBH was associated with increased odds of mortality (adjusted OR [AOR], 1.11; 95% CI, 1.10-1.12) and tracheostomy use (AOR, 1.33; 95% CI, 1.29-1.37), as well as greater hospitalization costs (β coefficient, +$1,083; 95% CI, $882-$1,294) and longer lengths of stay (β coefficient, +3.3 days; 95% CI, 3.2-3.3 days).After accounting for differences between patient cohorts, high safety net burden was associated independently with inferior clinical outcomes and increased costs after ARF hospitalizations. These findings emphasize the need for health care reform to ameliorate disparities within these safety net centers, which treat our most vulnerable populations. |
| Databáze: | OpenAIRE |
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