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A Description of Children Dependent on Long Term Ventilation via Tracheostomy and Their Hospital Resource Use
Barbara K Giambra1, Colleen Mangeot2, Dan T Benscoter3
1Cincinnati Children's Hospital Medical Center, OH, United States of America; University of Cincinnati College of Nursing, OH, United States of America.
Insights
A small fraction of hospitalized children have long-term invasive ventilator dependence (LTVD), requiring complex care. This study found no regional differences in their hospital length of stay, charges, or readmissions.
Area of Science:
- Pediatric critical care medicine
- Healthcare services research
- Health informatics
Background:
- Long-term invasive ventilator dependence (LTVD) affects a subset of children requiring complex medical care.
- Understanding the characteristics and healthcare utilization of this population is crucial for resource allocation and care planning.
Purpose of the Study:
- To determine the proportion of children with established LTVD hospitalized in 2014.
- To analyze regional variations in hospital length of stay, associated charges, and readmission rates for these children.
Main Methods:
- Retrospective cohort study utilizing the Pediatric Health Information System database (2014).
- An algorithm identified children with LTVD, excluding normal newborns and chemotherapy patients.
- Hospitals were geographically grouped, and statistical modeling analyzed length of stay, charges, and readmissions.
Main Results:
- 0.4% (2235 of 615,883) of discharged children had established LTVD.
- Most children with LTVD had multiple complex chronic conditions (97%) and required multiple medical devices (71%).
- No statistically significant regional variations were observed in length of stay, charges, or readmissions after adjusting for key covariates.
Conclusions:
- Children with established LTVD represent a small but high-need patient group.
- Their care is resource-intensive due to complex comorbidities and device reliance.
- This study found no evidence of regional disparities in key healthcare utilization metrics for this population.
Purpose:
To describe the proportion of children with an index hospitalization in 2014 who had established long-term invasive ventilator dependence (LTVD), and determine regional variation in hospital length of stay, charges, and readmissions.
Design And Methods:
Multicenter, longitudinal, retrospective cohort study using a recently established algorithm to identify children with LTVD from the Pediatric Health Information System database with an index hospitalization at least once during 2014, excluding normal newborn care or chemotherapy, and the subset with established LTVD. Hospitals were grouped by geographic regions. Analysis included descriptive statistics and multi-variable mixed modeling for length of stay, charges, and readmissions.
Results:
Of the 615,883 unique children discharged from 45 children's hospitals in 2014, 2235 (0.4%) had established LTVD. Of these, 342 (15%) were hospitalized in the Northeast, 677 (30%) Midwest, 733 (32%) South and 481 (22%) West. Most had at least two complex chronic conditions (97%) and used a medical device for at least two body systems (71%). No statistically significant regional variation was found for length of stay, charges, or readmissions after adjustment for child demographics, admission type, disposition, primary diagnosis, ICU stay, and number of chronic conditions.
Conclusions:
This study characterized the population of children with LTVD hospitalized in 2014. No regional variation was found for length of stay, charges, or readmissions.
Practice Implications:
Children with established LTVD make up a small subset of all children admitted to children's hospitals however, they require substantial, costly, multifaceted care as most have additional complex chronic conditions and require multiple medical devices.
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