Respiratory care
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The integrated prospective payment program (IPP), which encourages the integrated care of mechanically ventilated patients in order to reduce the heavy utilization of high-cost ICUs, has been implemented by Taiwan's Bureau of National Health Insurance since July 2000. The aim of this study was to assess the impact of this program on weaning, hospital stay, mortality, and cost for patients requiring prolonged mechanical ventilation (PMV). ⋯ Implementation of the IPP program reduced the total hospitalization cost, increased the duration of mechanical ventilation usage and stay, and reduced the weaning rate in PMV patients.
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Randomized Controlled Trial
Effect of visualization of raw graphic polysomnography data by sleep apnea patients on adherence to CPAP therapy.
CPAP is considered to be the cornerstone of therapy for obstructive sleep apnea. However, adherence to this treatment is frequently poor, which may lead to ongoing symptoms, including daytime sleepiness and poor cognitive function. We aimed to determine the efficacy of showing patients their raw graphic polysomnography (PSG) data in increasing their CPAP adherence. ⋯ Showing patients raw graphic PSG data does not seem to improve adherence to CPAP. BMI is a very strong predictor of CPAP adherence.
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For patients with chronic respiratory failure or sleep breathing disorders, adaptation and training are important prerequisites for successful home noninvasive ventilation (NIV) and CPAP. In Europe, management of NIV/CPAP is sometimes performed by physiotherapists (PTs). However, their role within the NIV/CPAP management team is not well defined. ⋯ Our study has demonstrated that the PTs can play a key role in the respiratory care management of patients with chronic respiratory disease and sleep breathing disorders with neuromuscular diseases requiring higher time consumption, and the inclusion of PTs in the NIV/CPAP management procedure reduces the time spent by other health professionals. The cost effectiveness of this management needs to be verified in larger clinical trial settings.
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The aging Taiwan population is expected to require vast medical resources, including prolonged mechanical ventilation (PMV). This study determined the trends in hospital resource utilization and associated factors in PMV patients in Taiwan. ⋯ These population-based data demonstrated a decrease in the prevalence of PMV, especially for older patients, and that stay decreased; however, hospital treatment costs increased. Moreover, healthcare providers and patients should recognize that attributes of both the patient and the hospital may affect hospital resource utilization. Additionally, these analytical results should be applicable to similar populations in other countries.