The Influence of Institution and Physician Characteristics on the Length of Ventilator Use in Prolonged Mechanical Ventilation Patients

Abstract

Background:

The definition of prolonged mechanical ventilation (PMV) continued using ventilator over 21 days. The problem of PMV patients were increase in many countries. In Taiwan, the number of PMV patients was 7.24 times higher in 2009 than in 1995. Previous studies have investigated the factor of ventilator liberation, but no studies examined the factor of institution and physicians’ characteristic. In this study, we investigated the influence of institution and physician characteristics on the length of ventilator use day in PMV patients.

Methods:

This retrospective study analyzed a cohort of PMV patients who were age ≥ 17 using a population-based database from the Taiwan National Health Research Institutes Database from 2006 to 2010. The T-test, ANOVA and Multiple Regression Analysis were used in the study.

Results:

A total of 30,576 patients were included in 2006-2010, exclude the patients who death within half year (10,234 patients); there were 20342 patients in final analysis. For the institution characteristics; Comparing to medical center, the regional hospital, district hospital and others has higher day of using ventilator from 14.94 to 112.8 days (P < .05). The average days of using ventilator the private hospital is 5.14 days fewer than the public hospital. For the physician Characteristics, the physician in age 41-45 and over 51 have longer days compare to age under 35 with 2.19 days (P < .05) and 4.78 days (P < .05). The physician has higher services volume, his patients have a higher average ventilator use days.

Conclusions:

Both of the institution and physician characteristics influence the length of ventilator use day in PMV patients. They are in the non-medical center and public hospital, have higher ventilator use days. Physician has higher age or patient service volume, his PMV patients have higher ventilator use days.

Variables	N	Mean	Std	P-value	Estimate	Std	P-value
Level of health-care organization	&nbsp;	&nbsp;	&nbsp;	<0.001	&nbsp;	&nbsp;	&nbsp;
Medical center	7736	40.5	30.0	&nbsp;	&nbsp;	&nbsp;	&nbsp;
Regional hospital	8222	58.8	52.6	&nbsp;	14.94	0.72	<0.001
District hospital	4039	149.7	52.7	&nbsp;	98.49	0.92	<0.001
others	345	164.9	30.4	&nbsp;	112.8	2.45	<0.001
Ownership of organization	&nbsp;	&nbsp;	&nbsp;	0.062	&nbsp;	&nbsp;	&nbsp;
Public hospital	4771	70.2	61.5	&nbsp;	&nbsp;	&nbsp;	&nbsp;
Private hospital	15571	72.1	61.9	&nbsp;	-5.14	0.75	<0.001
Physician age	&nbsp;	&nbsp;	&nbsp;	<0.001	&nbsp;	&nbsp;	&nbsp;
Under 35	3561	63.5	55.5	&nbsp;	&nbsp;	&nbsp;	&nbsp;
36-40	5253	66.6	59.3	&nbsp;	0.57	0.96	0.552
41-45	4879	70.8	62.0	&nbsp;	2.19	0.97	0.024
46-50	3589	74.8	62.8	&nbsp;	1.68	1.04	0.107
Over 50	3060	87.8	68.0	&nbsp;	4.78	1.10	<0.001
Patient services volume	&nbsp;	&nbsp;	&nbsp;	<0.001	&nbsp;	&nbsp;	&nbsp;
Low	656	50.7	47.0	&nbsp;	&nbsp;	&nbsp;	&nbsp;
Median	4713	71.1	62.4	&nbsp;	2.40	1.83	0.189
High	14973	72.8	62.0	&nbsp;	4.35	1.76	0.013
Wean mechanical ventilator	&nbsp;	&nbsp;	&nbsp;	<0.001	&nbsp;	&nbsp;	&nbsp;
No	7238	90.5	69.4	&nbsp;	&nbsp;	&nbsp;	&nbsp;
Yes	13104	61.3	54.5	&nbsp;	-9.97	0.67	<0.001