• Chin-Jung Liu, Pei-Tseng Kung, Chia-Chen Chu, Wen-Yu Chou, Yueh-Hsin Wang, and Wen-Chen Tsai.
• Department of Public Health, China Medical University, Taichung, Taiwan, ROC; Department of Respiratory Therapy, China Medical University Hospital, China Medical University, Taichung, Taiwan, ROC. Electronic address: cjliu@mail.cmu.edu.tw.
• Health Policy. 2018 Sep 1; 122 (9): 970-976.

ObjectivesAn integrated delivery system with a prospective payment program (IPP) for prolonged mechanical ventilation (PMV) was launched by Taiwan's National Health Insurance (NHI) due to the costly and limited ICU resources. This study aimed to analyze the effectiveness of IPP and evaluate the factors associated with successful weaning and survival among patients with PMV.MethodsTaiwan's NHI Research Database was searched to obtain the data of patients aged ≥17 years who had PMV from 2006 to 2010 (N=50,570). A 1:1 propensity score matching approach was used to compare patients with and without IPP (N=30,576). Cox proportional hazards modeling was used to examine the factors related to successful weaning and survival.ResultsThe related factors of lower weaning rate in IPP participants (hazard ratio [HR]=0.84), were older age, higher income, catastrophic illness (HR=0.87), and higher comorbidity. The effectiveness of IPP intervention for the PMV patients showed longer days of hospitalization, longer ventilation days, higher survival rate, and higher medical costs (in respiratory care center, respiratory care ward). The 6-month mortality rate was lower (34.0% vs. 32.9%). The death risk of IPP patients compared to those non-IPP patients was lower (HR=0.91, P<0.001).ConclusionsThe policy of IPP for PMV patients showed higher survival rate although it was costly and related to lower weaning rate.Copyright © 2018 Elsevier B.V. All rights reserved.

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