Patients undergoing mechanical ventilation with tracheostomy have a high mortality rate and consume a significant amount of resources in the Intensive Care Unit. Advanced age and chronic illnesses are highly associated with mortality. Managed care has been somewhat successful in reducing the use of these expensive resources, but whether or not survival is adversely impacted is not known. Discharge abstracts from the Statewide Planning and Research Cooperative System in New York for a population of 33,793 patients discharged under DRG 483 during 1992-1996 were selected for analysis. A multivariate Cox Proportional Hazard analysis was preformed to determine the major determinants of survival, and to determine if managed care participation impacted survival. Although managed care patients had a significantly lower crude mortality rate than the rest of the population; after adjustment for age and comorbidity in a multivariate model, managed care status had no significant association with survival. The results imply that the reduction in crude mortality observed among managed care patients in DRG 483 is primarily due to patient selection rather more effective health care delivery. These findings inform health care administrators and policy-makers of the impact of a more restrictive health care delivery system change on ICU health outcomes for the system’s sickest and most costly patients.
Learning Objectives: Participants will be able to evaluate the role of delivery system changes on hospital survival for the health care system’s sickest and most expensive patients.
Keywords: Health Service, Managed Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.