Disposition of tracheostomized patients in New York State 1992-1996

Purpose: Patients undergoing tracheostomy for prolonged mechanical ventilation expend a significant amount of resources, during and after discharge from the hospital. This study was designed to determine the final disposition of survivors of tracheostomies for prolonged mechanical ventilation. Methods: Discharge data for the period 1992-1996 was requested from the New York Statewide Planning and Research Cooperative System (SPARCS). All discharges (n=34701) from Diagnosis Related Group (DRG) 483 were included. DRG 483 includes all patients with tracheostomies, except those with ear, nose and throat diagnoses. In practical terms, it is applied to patients with prolonged mechanical ventilation. Results: The final disposition of the survivors shows a decreasing trend towards discharge home at all age groups in the five year period (38.6%, 32.7%, 29.2% 28.4%, 22.8%), while the percentage of patients going home with home services remains nearly unchanged (14.7%, 15.8%, 14%, 15.6% and 12.3%). There is an increasing trend towards discharge to a residential health care faculty (i.e. nursing home) (19.8%, 22.5%, 22.9%, 26.2% and 31.6% in 1996). The number of patients discharged to the category "other health care facility" shows the same pattern, (16.1%, 17.9%, 20% 21.5% and 24.1%). Finally, a minority of patients is discharged to other acute care facility (9.1%, 9.1%, 8.1% 5.3%, 7.1%) or other (1.7%, 2%, 5.8%, 3%, and 2%). Conclusions: An increasing number of patients undergoing prolonged mechanical ventilation are discharged to long term facilities, incurring in significant after hospital expense. Clinical Implications: The data presented should prove useful when establishing a long-term prognosis from the quality of life and social perspective. Moreover, the cost of care of this population will come under scrutiny as health care resources are rationed.