RESUMO
The author statistically analyzes 542 patients who were hospitalized in the Prolonged Respiratory Care Unit of Bethesda Lutheran Medical Center in St. Paul, Minnesota, between 1979 and 1989. A demographic description of the patients, an analysis of discharge status, and a discussion of reimbursement for care are presented. It is apparent from this analysis that: 1) there is a large number of patients who will require chronic ventilator support, 2) weaning of "unweanable" patients can occur in selected cases and can be most expeditiously accomplished in specialized units, 3) these specialized units are cost effective, and early transfer from the DRG-reimbursed ICUs would benefit not only the patient but also the reimbursing agent and referral hospital, 4) specialized, adequately funded centers for unweanable patients need to be developed, and 5) further studies and education concerning the imprudent use of ventilators must be implemented by the appropriate physician organizations.
Assuntos
Assistência de Longa Duração , Pneumopatias Obstrutivas/reabilitação , Insuficiência Respiratória/reabilitação , Serviço Hospitalar de Terapia Respiratória , Desmame do Respirador , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Respiração Artificial/economia , Adulto , Idoso , Custos e Análise de Custo , Feminino , Humanos , Masculino , MinnesotaRESUMO
This article provides a review of patient care statistics for a Prolonged Respiratory Care Unit located at Bethesda Lutheran Medical Center in St. Paul, MN. This unique unit, originally reviewed in Chest, was originated to provide long-term respiratory care to patients who require extensive respiratory therapy modalities, but could not be maintained in the home or other institutional settings initially because of complications of their disease processes or because of their need for specialized care and equipment. Utilization of this cost effective unit has been beneficial to the medical community not only in the Midwest but throughout the United States. This statistical update further substantiates the need for care of patients with chronic or prolonged respiratory disease in similarly modelled units. The data present a strong argument for qualification of this unit for exemption status from DRG (diagnostic related grouping) Medicare-Medicaid reimbursement rules. An outgrowth of this unit is to provide home care service to ventilator-dependent patients and to possibly generate discussion and formulation of regional referral centers for care of patients with severe respiratory disease.
Assuntos
Assistência de Longa Duração , Unidades de Cuidados Respiratórios , Adolescente , Adulto , Fatores Etários , Idoso , Análise Custo-Benefício , Grupos Diagnósticos Relacionados , Honorários e Preços , Feminino , Serviços de Assistência Domiciliar , Humanos , Tempo de Internação , Assistência de Longa Duração/economia , Masculino , Pessoa de Meia-Idade , Minnesota , Alta do Paciente , Mecanismo de Reembolso , Unidades de Cuidados Respiratórios/economia , Fatores SexuaisRESUMO
A major medical social problem at present is the need for care of patients with chronic or prolonged illness. This is particularly true in the case of respiratory disease, which has undergone major strides in prolonging life through the increased use of respirators and improved methods of medical care. In response to this need, St. Paul, Minnesota's Bethesda Lutheran Medical Center opened a prolonged respiratory care unit on Aug 21, 1979. A review and general assessment of this operation is presented. At the time of this review, the unit has been open for approximately 18 months. The obvious benefits in terms of patient care cost as well as the improvement in patient quality of life inherent in this type of specialized unit, which has an adequately trained staff, are described.
