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Association of Proximity to a Long-Term Acute Care Hospital With Hospital Tracheostomy Practices
- Source :
- Crit Care Med
- Publication Year :
- 2023
-
Abstract
- OBJECTIVES Availability of long-term acute care hospitals has been associated with hospital discharge practices. It is unclear if long-term acute care hospital availability can influence patient care decisions. We sought to determine the association of long-term acute care hospital availability at different hospitals with the likelihood of tracheostomy. DESIGN Retrospective cohort study. SETTING California Patient Discharge Database, 2016-2018. PATIENTS Adult patients receiving mechanical ventilation for respiratory failure. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Using the California Patient Discharge Database 2016-2018, we identified all mechanically ventilated patients and those who received tracheostomy. We determine the association between tracheostomy and the distance between each hospital and the nearest long-term acute care hospital and the number of long-term acute care hospital beds within 20 miles of each hospital. Among 281,502 hospitalizations where a patient received mechanical ventilation, 22,899 (8.1%) received a tracheostomy. Patients admitted to a hospital closer to a long-term acute care hospital compared with those furthest from a long-term acute care hospital had 38.9% (95% CI, 33.3-44.6%) higher odds of tracheostomy (closest hospitals 8.7% vs furthest hospitals 6.3%, adjusted odds ratio = 1.65; 95% CI, 1.40-1.95). Patients had a 32.4% (95% CI, 27.6-37.3%) higher risk of tracheostomy when admitted to a hospital with more long-term acute care hospital beds in the immediate vicinity (most long-term acute care hospital beds within 20 miles 8.9% vs fewest long-term acute care hospital beds 6.7%, adjusted odds ratio = 1.54; 95% CI, 1.31-1.80). Distance to the nearest long-term acute care hospital was inversely correlated with hospital risk-adjusted tracheostomy rates (ρ = -0.25; p < 0.0001). The number of long-term acute care hospital beds within 20 miles was positively correlated with hospital risk-adjusted tracheostomy rates (ρ = 0.22; p < 0.0001). CONCLUSIONS Proximity and availability of long-term acute care hospital beds were associated with patient odds of tracheostomy and hospital tracheostomy practices. These findings suggest a hospital effect on tracheostomy decision-making over and above patient case-mix. Future studies focusing on shared decision-making for tracheostomy are needed to ensure goal-concordant care for prolonged mechanical ventilation.
- Subjects :
- Adult
Male
medicine.medical_specialty
Future studies
Sociodemographic Factors
medicine.medical_treatment
Psychological intervention
Transportation
Comorbidity
Critical Care and Intensive Care Medicine
California
Article
Tracheostomy
Acute care
medicine
Hospital discharge
Humans
Hospital Mortality
Aged
Retrospective Studies
Mechanical ventilation
Aged, 80 and over
business.industry
Retrospective cohort study
Odds ratio
Middle Aged
Long-Term Care
Respiration, Artificial
Hospitals
Respiratory failure
Emergency medicine
Female
business
Respiratory Insufficiency
Subjects
Details
- ISSN :
- 15300293
- Volume :
- 50
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Critical care medicine
- Accession number :
- edsair.doi.dedup.....75bae4f125bb7ded402ceaa2addca8a7