Patterns in costs and outcomes for patients with prolonged mechanical ventilation undergoing tracheostomy: An analysis of discharges under diagnosis-related group 483 in New York State from 1992 to 1996

Objective: To analyze the costs and discharge status for patients with prol onged mechanical ventilation undergoing tracheostomy. Design: Retrospective analysis of a statewide database. Patients: All patients (n = 37,573) >18 yrs of age who had prolonged mechan ical ventilation (procedure code 96.72) and were discharged from the hospit al between 1992 and 1996 with a final DRG code of 483. Interventions: None. Measurements and Main Results: Rates of change in discharges and hospital r eimbursements and the cost per survivor were examined by case payment group s and discharge year. A direct relation between volume and reimbursement ra te was seen over time, although the patient age distributions remained rela tively stable. The greatest increase in volume was from 1995 to 1996. For m ost years, there was a consistent inverse relation between age and survival , with older survivors being more likely to be discharged to residential he althcare facilities and younger patients more likely to be discharged home. There was a consistent direct relation between age and cost per survivor, mainly the result of improved survival rather than decreased reimbursements in later years. Conclusions: More controlled reimbursements and improved overall survival r ates for DRG 483 have contributed to the improved cost per survivor among a ll age groups over the period. Given the greater proportion of elderly that do not survive or who are placed into residential healthcare facilities, m ore scrutiny is needed concerning the use of DRG 483 resources so that care is better coordinated for these patients in the inpatient and postacute ca re settings.