000			04132nam a22006257a 4500
008			210607s20212021 xxu||||| |||| 00| 0 eng d
022			_a0012-3692
024			_a10.1016/j.chest.2020.11.022 [doi]
024			_aS0012-3692(20)35305-8 [pii]
040			_aOvid MEDLINE(R)
099			_a33253754
245			_aA Minority of Patients on Mechanical Ventilation Consume Disproportionate Resources: A Retrospective Cohort Study.
251			_aChest. 159(5):1854-1866, 2021 05.
252			_aChest. 159(5):1854-1866, 2021 05.
252			_zChest. 2020 Nov 28
253			_aChest
260			_c2021
260			_fFY2021
265			_saheadofprint
265			_sppublish
266			_d2021-02-17
268			_aChest. 2020 Nov 28
520			_aBACKGROUND: The Pareto principle states that the majority of any effect comes from a minority of the causes. This property is widely used in quality improvement science.
520			_aINTERPRETATION: Patients undergoing MV in the highest quintiles according to duration of MV consume a disproportionate amount of resources, as evidenced by MV duration, hospital LOS, and costs, making them a potential target for streamlining MV care. Copyright (c) 2020. Published by Elsevier Inc.
520			_aRESEARCH QUESTION: Among patients requiring mechanical ventilation (MV), are there subgroups according to MV duration that may serve as potential nodes for high-value interventions aimed at reducing costs without compromising quality?
520			_aRESULTS: A total of 691,961 patients were included in the analysis. Median [interquartile range] duration of MV in days by quintile was as follows: quintile 1 (Q1), 1 [1, 1]; Q2, 2 [2, 2]; Q3, 3 [3, 3]; Q4, 6 [6, 7]; and Q5, 13 [10, 19]. Median [interquartile range] post-MV onset LOS (Q1, 2 [0, 5]; Q5, 17 [12, 26]) and hospital costs (Q1, _15,671 [ _9,180, _27,901]; Q5, _70,133 [ _47,136, _108,032]) rose from Q1 through Q5. Patients in Q5 consumed 47.7% of all post-MV initiation hospital days among all patients requiring MV, and the mean per-patient hospital costs in Q5 exceeded the sum of costs incurred by Q1 to Q3. Adjusted marginal mean (95% CI) hospital costs rose exponentially from Q1 through Q5: Q2 vs Q1, _3,976 ( _3,354, _4,598); Q3 vs Q2, _5,532 ( _5,103, _5,961); Q4 vs Q3, _11,705 ( _11,071, _12,339); and Q5 vs Q4, _26,416 ( _25,215, _27,616).
520			_aSTUDY DESIGN AND METHODS: This multicenter retrospective cohort study included approximately 780 hospitals in the Premier Research Database (2014-2018). Patients receiving MV were identified by using International Classification of Diseases, Ninth Revision, Clinical Modification, and International Classification of Diseases, Tenth Revision, codes. They were then divided into quintiles according to MV duration; their hospital costs, post-MV onset length of stay (LOS), ICU LOS, and cumulative post-MV onset hospital days per quintile were compared.
546			_aEnglish
650			_a*Resource Allocation/ec [Economics]
650			_a*Respiration, Artificial/ec [Economics]
650			_aAnti-Bacterial Agents/ec [Economics]
650			_aBronchoscopy/ec [Economics]
650			_aComorbidity
650			_aCross Infection/ec [Economics]
650			_aDatabases, Factual
650			_aFemale
650			_aHospital Costs
650			_aHumans
650			_aLength of Stay/ec [Economics]
650			_aMale
650			_aMiddle Aged
650			_aPneumonia, Ventilator-Associated/dt [Drug Therapy]
650			_aPneumonia, Ventilator-Associated/ec [Economics]
650			_aPneumonia, Ventilator-Associated/mi [Microbiology]
650			_aQuality Assurance, Health Care
650			_aRetrospective Studies
650			_aTracheostomy/ec [Economics]
651			_aMedStar Washington Hospital Center
656			_aMedicine/Pulmonary-Critical Care
657			_aJournal Article
700			_aShorr, Andrew F
790			_aNathanson BH, Shorr AF, Ways J, Zilberberg MD
856			_uhttps://dx.doi.org/10.1016/j.chest.2020.11.022 _zhttps://dx.doi.org/10.1016/j.chest.2020.11.022
942			_cART _dArticle
999			_c6070 _d6070