Survival and medical utilization of children and adolescents with prolonged ventilator-dependent and associated factors

• Published in: PloS one Vol. 12; no. 6; p. e0179274
• Main Authors: Pai, Szu-Chi, Kung, Pei-Tseng, Chou, Wen-Yu, Kuo, Tsunghuai, Tsai, Wen-Chen
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 19.06.2017; Public Library of Science (PLoS)
• Subjects: Adolescent; Adolescents; Analysis; Central Nervous System Diseases - economics; Central Nervous System Diseases - mortality; Central Nervous System Diseases - pathology; Child; Child, Preschool; Children; Demographics; Emergency medical care; Emergency medical services; Engineering and Technology; Female; Health aspects; Health Care Costs; Hospitalization - economics; Humans; Infant; Infant, Newborn; Insurance; Kaplan-Meier Estimate; Male; Mathematical models; Mechanical ventilation; Medical care utilization; Medicine and Health Sciences; Mortality; National Health Programs; Patient outcomes; Patients; Pediatrics; People and Places; Pilot projects; Proportional Hazards Models; Regression analysis; Respiration, Artificial - economics; Respiratory Insufficiency - economics; Respiratory Insufficiency - mortality; Respiratory Insufficiency - pathology; Respiratory therapy; Retrospective Studies; Survival; Taiwan; Teenagers; Ventilation; Ventilators; Youth; Taiwan; United Kingdom > UK; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0179274

Over the course of a year, more than 20,000 patients in Taiwan require prolonged mechanical ventilation (PMV). Data from the National Health Insurance Research Database for patients between 2005 and 2011 were used to conduct a retrospective analysis on ventilator dependence. The study subjects were PMV patients aged <17 years in Taiwan. A multiple regression model employing general estimating equations was applied to investigate the factors affecting the use of medical resources by children and adolescent PMV patients. A Cox proportional hazard model was incorporated to explore the factors affecting the survival of these patients. Data were collected for a total of 1,019 children and adolescent PMV patients in Taiwan. The results revealed that the average number of outpatient visits per subject was 32.1 times per year, whereas emergency treatments averaged 1.56 times per year per subject and hospitalizations averaged 160.8 days per year per subject. Regarding average annual medical costs, hospitalizations accounted for the largest portion at NT$821,703 per year per subject, followed by outpatient care at NT$123,136 per year per subject and emergency care at NT$3,806 per year per subject. The demographic results indicated that the patients were predominately male (61.24%), with those under 1 year of age accounting for the highest percentage (36.38%). According to the Kaplan-Meier curve, the 1-year and 5-year mortality rates of the patients were approximately 32% and 47%, respectively. The following factors affecting the survival rate were considered: age, the Charlson Comorbidity Index (CCI), diagnosis type necessitating ventilator use, and whether an invasive ventilator was used. This study investigated the use of medical resources and the survival rates of children and adolescent PMV patients. The findings of this study can serve as a reference for the National Health Insurance Administration in promoting its future integrated pilot projects on ventilator dependency.