Abstract and Introduction
Abstract
Objective: Patients requiring prolonged acute mechanical ventilation (PAMV, defined as mechanical ventilation ≥96 hrs) have hospital survival rates similar to those requiring <96 hrs of mechanical ventilation and consume about two thirds of hospital resources devoted to mechanical ventilation care. Because of this disproportionate resource utilization and the shifting U.S. demographics, we projected the expected volume of adult PAMV cases through year 2020.
Design: We used data from the National Inpatient Sample/Health Care Utilization Project of the Agency for Healthcare Research and Quality from 2000 to 2005 to calculate historic annual age-adjusted PAMV incidence rates using estimated population statistics from the U.S. Census Bureau. To predict future growth by age group, we fit linear regression models to the historic incidence rate changes. Age-adjusted estimates were computed using population projections obtained from the U.S. Census Bureau.
Setting: U.S. hospitals.
Patients: Nationally representative sample of U.S. hospital discharges with PAMV (code 96.72 from the International Classification of Diseases, Ninth Revision).
Interventions: None.
Measurements and Main Results: Historic annualized increase in PAMV was ~5.5%, compared with ~1% per annum growth in both U.S. population and hospital admissions. The fastest annualized growth was observed among 44-65 (7.9%) followed by 18-44 (4.7%), ≥85 (4.6%), and 65-84 (3.4%) age groups. Factoring in both age-specific growth in PAMV population and overall U.S. adult population changes, we project PAMV to more than double from approximately 250,000 cases in 2000 to 605,898 cases by year 2020.
Conclusions: Patients undergoing PAMV are a large and resource-intensive population whose increase outpaces growth in the general U.S. population and in overall hospital volume. Policy makers must factor this projected rapid growth in frequency of PAMV into future resource and work force planning. Given the resource-intensive nature of these patients, strategies need to be developed to optimize their care and to increase efficiency of healthcare delivery to this large and growing population.
Introduction
Workforce shortages within the United States healthcare field, and particularly in hospitals, are becoming a prominent issue facing policy makers. For the nursing profession alone, by year 2020 the United States can expect a deficit of >1 million. Nursing vacancies, although most prominent, are not the only personnel shortages being noted, with high vacancy rates reported for other hospital personnel, including pharmacists and respiratory therapists. Specific to the intensive care unit (ICU), >10% of the units are reporting nursing shortages, forcing closure of 3.6-beds/unit on average. Compounding the urgency of the situation, by year 2020 we can expect a 20% shortfall in the supply of intensivists due purely to the aging of the population. However, in view of quality and cost advantages associated with dedicated intensivist care and increasing per capita healthcare consumption, this number may substantially underestimate the actual shortfall.
On the other side of the equation, the demand for health care has been growing and is expected to continue its rapid pace. In the ICU, Medicare admissions alone increased by 12.6% over a recent 5-yr period, and in the face of an aging population and continuing advances in disease management, this accelerated pace of ICU utilization will continue. One well-understood driver of this supply-demand imbalance is the change in the composition of the U.S. population, with the aging of the baby-boomer generation and the increased life expectancy leading to a disproportionate growth among the older age groups. The contribution of condition-specific changes to the growth in hospital utilization is less well understood.
Given the tenuousness of the supply-demand balance in the U.S. healthcare system, accurate information on the present trends and, more importantly, on the projections for future demand is critical in order to ensure appropriate resource development and allocation. We recently identified a population of adult patients on prolonged acute mechanical ventilation (PAMV, defined as mechanical ventilation ≥96 hrs) who have hospital survival rates similar to those who require <96 hrs of mechanical ventilation. At the same time, they consume nearly two thirds of the total hospital resources devoted to mechanical ventilation care. With approximately 300,000 cases in 2003, and nearly 7 million hospital days and $16 billion in hospital expenditures, longitudinal growth trends in this population may be an important determinant of future ICU and hospital resource consumption. To shed light on this issue, we examined age-specific volume changes in this population over a recent 6-yr period and used those numbers to project the age-adjusted growth in this group through year 2020, taking into account both the changing incidence in PAMV and the changing composition of the U.S. population.