Hospital Variation in Non-Invasive Ventilation Use for Acute Respiratory Failure Due to COPD Exacerbation

Spyridon Fortis,1,2 Yubo Gao,1,3 Amy M J O’Shea,1,3 Brice Beck,1 Peter Kaboli,1,3 Mary Vaughan Sarrazin1,3 1Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA; 2Department of Internal Medicine, Division of Pulmonary, Critical Care...

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Autores principales:	Fortis S, Gao Y, O’Shea AMJ, Beck B, Kaboli P, Vaughan Sarrazin M
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	pulmonary disease chronic obstructive epidemiology non-invasive ventilation Diseases of the respiratory system RC705-779
Acceso en línea:	https://doaj.org/article/d94142fc62ac4d0badf630cc21d59fe1
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spelling	oai:doaj.org-article:d94142fc62ac4d0badf630cc21d59fe12021-11-18T19:40:25ZHospital Variation in Non-Invasive Ventilation Use for Acute Respiratory Failure Due to COPD Exacerbation1178-2005https://doaj.org/article/d94142fc62ac4d0badf630cc21d59fe12021-11-01T00:00:00Zhttps://www.dovepress.com/hospital-variation-in-non-invasive-ventilation-use-for-acute-respirato-peer-reviewed-fulltext-article-COPDhttps://doaj.org/toc/1178-2005Spyridon Fortis,1,2 Yubo Gao,1,3 Amy M J O’Shea,1,3 Brice Beck,1 Peter Kaboli,1,3 Mary Vaughan Sarrazin1,3 1Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA; 2Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupation Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA; 3Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USACorrespondence: Spyridon FortisDepartment of Internal Medicine, Division of Pulmonary, Critical Care and Occupation Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive – C33 GH, Iowa City, IA, 52242, USAEmail spyridon-fortis@uiowa.eduBackground: Non-invasive mechanical ventilation (NIV) use in patients admitted with acute respiratory failure due to COPD exacerbations (AECOPDs) varies significantly between hospitals. However, previous literature did not account for patients’ illness severity. Our objective was to examine the variation in risk-standardized NIV use after adjusting for illness severity.Methods: We retrospectively analyzed AECOPD hospitalizations from 2011 to 2017 at 106 acute-care Veterans Health Administration (VA) hospitals in the USA. We stratified hospitals based on the percentage of NIV use among patients who received ventilation support within the first 24 hours of admission into quartiles, and compared patient characteristics. We calculated the risk-standardized NIV % using hierarchical models adjusting for comorbidities and severity of illness. We then stratified the hospitals by risk-standardized NIV % into quartiles and compared hospital characteristics between quartiles. We also compared the risk-standardized NIV % between rural and urban hospitals.Results: In 42,048 admissions for AECOPD over 6 years, the median risk-standardized initial NIV % was 57.3% (interquartile interval [IQI]=41.9– 64.4%). Hospitals in the highest risk-standardized NIV % quartiles cared for more rural patients, used invasive ventilators less frequently, and had longer length of hospital stay, but had no difference in mortality relative to the hospitals in the lowest quartiles. The risk-standardized NIV % was 65.3% (IQI=34.2– 84.2%) in rural and 55.1% (IQI=10.8– 86.6%) in urban hospitals (p=0.047), but hospital mortality did not differ between the two groups.Conclusion: NIV use varied significantly across hospitals, with rural hospitals having higher risk-standardized NIV % rates than urban hospitals. Further research should investigate the exact mechanism of variation in NIV use between rural and urban hospitals.Keywords: pulmonary disease, chronic obstructive, epidemiology, non-invasive ventilationFortis SGao YO’Shea AMJBeck BKaboli PVaughan Sarrazin MDove Medical Pressarticlepulmonary diseasechronic obstructiveepidemiologynon-invasive ventilationDiseases of the respiratory systemRC705-779ENInternational Journal of COPD, Vol Volume 16, Pp 3157-3166 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	pulmonary disease chronic obstructive epidemiology non-invasive ventilation Diseases of the respiratory system RC705-779
spellingShingle	pulmonary disease chronic obstructive epidemiology non-invasive ventilation Diseases of the respiratory system RC705-779 Fortis S Gao Y O’Shea AMJ Beck B Kaboli P Vaughan Sarrazin M Hospital Variation in Non-Invasive Ventilation Use for Acute Respiratory Failure Due to COPD Exacerbation
description	Spyridon Fortis,1,2 Yubo Gao,1,3 Amy M J O’Shea,1,3 Brice Beck,1 Peter Kaboli,1,3 Mary Vaughan Sarrazin1,3 1Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA; 2Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupation Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA; 3Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USACorrespondence: Spyridon FortisDepartment of Internal Medicine, Division of Pulmonary, Critical Care and Occupation Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive – C33 GH, Iowa City, IA, 52242, USAEmail spyridon-fortis@uiowa.eduBackground: Non-invasive mechanical ventilation (NIV) use in patients admitted with acute respiratory failure due to COPD exacerbations (AECOPDs) varies significantly between hospitals. However, previous literature did not account for patients’ illness severity. Our objective was to examine the variation in risk-standardized NIV use after adjusting for illness severity.Methods: We retrospectively analyzed AECOPD hospitalizations from 2011 to 2017 at 106 acute-care Veterans Health Administration (VA) hospitals in the USA. We stratified hospitals based on the percentage of NIV use among patients who received ventilation support within the first 24 hours of admission into quartiles, and compared patient characteristics. We calculated the risk-standardized NIV % using hierarchical models adjusting for comorbidities and severity of illness. We then stratified the hospitals by risk-standardized NIV % into quartiles and compared hospital characteristics between quartiles. We also compared the risk-standardized NIV % between rural and urban hospitals.Results: In 42,048 admissions for AECOPD over 6 years, the median risk-standardized initial NIV % was 57.3% (interquartile interval [IQI]=41.9– 64.4%). Hospitals in the highest risk-standardized NIV % quartiles cared for more rural patients, used invasive ventilators less frequently, and had longer length of hospital stay, but had no difference in mortality relative to the hospitals in the lowest quartiles. The risk-standardized NIV % was 65.3% (IQI=34.2– 84.2%) in rural and 55.1% (IQI=10.8– 86.6%) in urban hospitals (p=0.047), but hospital mortality did not differ between the two groups.Conclusion: NIV use varied significantly across hospitals, with rural hospitals having higher risk-standardized NIV % rates than urban hospitals. Further research should investigate the exact mechanism of variation in NIV use between rural and urban hospitals.Keywords: pulmonary disease, chronic obstructive, epidemiology, non-invasive ventilation
format	article
author	Fortis S Gao Y O’Shea AMJ Beck B Kaboli P Vaughan Sarrazin M
author_facet	Fortis S Gao Y O’Shea AMJ Beck B Kaboli P Vaughan Sarrazin M
author_sort	Fortis S
title	Hospital Variation in Non-Invasive Ventilation Use for Acute Respiratory Failure Due to COPD Exacerbation
title_short	Hospital Variation in Non-Invasive Ventilation Use for Acute Respiratory Failure Due to COPD Exacerbation
title_full	Hospital Variation in Non-Invasive Ventilation Use for Acute Respiratory Failure Due to COPD Exacerbation
title_fullStr	Hospital Variation in Non-Invasive Ventilation Use for Acute Respiratory Failure Due to COPD Exacerbation
title_full_unstemmed	Hospital Variation in Non-Invasive Ventilation Use for Acute Respiratory Failure Due to COPD Exacerbation
title_sort	hospital variation in non-invasive ventilation use for acute respiratory failure due to copd exacerbation
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/d94142fc62ac4d0badf630cc21d59fe1
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Hospital Variation in Non-Invasive Ventilation Use for Acute Respiratory Failure Due to COPD Exacerbation

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