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Comparison of care patterns and rehospitalizations for mechanically ventilated patients in New York and Ontario

Wunsch H, Hill AD, Scales DC, Fowler RA, Hua M. Ann Am Thorac Soc. 2019; 16(4):463-70. Epub 2019 Jan 8.

Rationale — Mechanically ventilated patients require complex care and are at high risk for rehospitalization, but different systems of care may result in different hospital discharge practices and rates of rehospitalization.

Objectives — To compare lengths of hospitalization, discharge patterns, and rehospitalization rates in New York (NY) in the US and Ontario (ON) in Canada.

Methods — We conducted a retrospective cohort study of mechanically ventilated patients who survived an acute care hospitalization in NY or ON from 2010-2012, using linkable administrative healthcare data.

Results — The primary outcome was the cumulative incidence of first rehospitalization within 30 days of discharge, accounting for the competing risk of death. Of 71,063 mechanically ventilated patients in NY, and 41,875 in ON who survived to hospital discharge, median length of initial hospital stay was similar in NY versus ON (15 days, Interquartile range (IQR) 8-28 vs 16 (9-30)), but was systematically shorter in NY when stratified by patient subgroups of different illness severity. Fewer patients in NY were discharged directly home (53.6% versus 71.4%). Of patients in NY, 15,527 (cumulative incidence 21.9%) had a first rehospitalization within 30 days versus 5,531 580 (cumulative incidence 13.23%) in Ontario, p<0.001. Incidence of rehospitalization was higher in NY across all subgroups assessed, with the greatest differences among patients with a tracheostomy (29.8% versus 13.3%, p<0.001), those who received dialysis during the hospitalization (31.9% versus 17.40%, p<0.001), and for patients not discharged directly home (27.6% versus 13.13% p<0.001).

Conclusions — Care patterns for mechanically ventilated patients in NY and ON are very different; mechanically ventilated patients who survive to hospital discharge in NY have shorter hospital stays, with higher rehospitalization rates within 30 days compared with ON.