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A Minority of Patients on Mechanical Ventilation Consume Disproportionate Resources: A Retrospective Cohort Study
Marya D Zilberberg1, Brian H Nathanson2, Judy Ways3
1EviMed Research Group, LLC, Goshen, MA.
Background:
The Pareto principle states that the majority of any effect comes from a minority of the causes. This property is widely used in quality improvement science.
Research Question:
Among patients requiring mechanical ventilation (MV), are there subgroups according to MV duration that may serve as potential nodes for high-value interventions aimed at reducing costs without compromising quality?
Study Design And Methods:
This multicenter retrospective cohort study included approximately 780 hospitals in the Premier Research Database (2014-2018). Patients receiving MV were identified by using International Classification of Diseases, Ninth Revision, Clinical Modification, and International Classification of Diseases, Tenth Revision, codes. They were then divided into quintiles according to MV duration; their hospital costs, post-MV onset length of stay (LOS), ICU LOS, and cumulative post-MV onset hospital days per quintile were compared.
Results:
A total of 691,961 patients were included in the analysis. Median [interquartile range] duration of MV in days by quintile was as follows: quintile 1 (Q1), 1 [1, 1]; Q2, 2 [2, 2]; Q3, 3 [3, 3]; Q4, 6 [6, 7]; and Q5, 13 [10, 19]. Median [interquartile range] post-MV onset LOS (Q1, 2 [0, 5]; Q5, 17 [12, 26]) and hospital costs (Q1, $15,671 [$9,180, $27,901]; Q5, $70,133 [$47,136, $108,032]) rose from Q1 through Q5. Patients in Q5 consumed 47.7% of all post-MV initiation hospital days among all patients requiring MV, and the mean per-patient hospital costs in Q5 exceeded the sum of costs incurred by Q1 to Q3. Adjusted marginal mean (95% CI) hospital costs rose exponentially from Q1 through Q5: Q2 vs Q1, $3,976 ($3,354, $4,598); Q3 vs Q2, $5,532 ($5,103, $5,961); Q4 vs Q3, $11,705 ($11,071, $12,339); and Q5 vs Q4, $26,416 ($25,215, $27,616).
Interpretation:
Patients undergoing MV in the highest quintiles according to duration of MV consume a disproportionate amount of resources, as evidenced by MV duration, hospital LOS, and costs, making them a potential target for streamlining MV care.
Insights
Patients on mechanical ventilation (MV) with longer durations consume a disproportionate amount of hospital resources. Identifying these high-resource users can guide targeted interventions to improve efficiency and reduce costs in MV care.
Area of Science:
- Healthcare Management
- Quality Improvement Science
- Health Economics
Background:
- The Pareto principle, or 80/20 rule, highlights that a minority of causes often drive a majority of effects.
- This principle is frequently applied in quality improvement initiatives to identify high-impact factors.
Purpose of the Study:
- To identify patient subgroups requiring mechanical ventilation (MV) based on duration.
- To determine if these subgroups represent potential targets for high-value interventions aimed at cost reduction without compromising care quality.
Main Methods:
- A multicenter retrospective cohort study analyzed data from approximately 780 hospitals (2014-2018).
- Patients receiving MV were identified using ICD codes and categorized into quintiles based on ventilation duration.
- Hospital costs, length of stay (LOS) post-MV, and ICU LOS were compared across quintiles.
Main Results:
- Analysis included 691,961 patients, with MV durations varying by quintile (Q1: 1 day, Q5: 13 days).
- Hospital costs and post-MV LOS increased exponentially from Q1 to Q5.
- The highest quintile (Q5) accounted for 47.7% of post-MV hospital days and incurred higher costs than Q1-Q3 combined.
Conclusions:
- Patients with longer mechanical ventilation durations consume a disproportionate share of healthcare resources.
- These high-duration MV subgroups are prime targets for interventions to streamline care and reduce costs effectively.
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