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Article ; Online: Reduction of healthcare costs by implementing palliative family conference with the decision to withdraw life-sustaining treatments

Hou-Tai Chang / Jih-Shuin Jerng / Duan-Rung Chen

Journal of the Formosan Medical Association, Vol 119, Iss 1, Pp 34-

2020 Volume 41

Abstract: Background: Evidence regarding the impact of early palliative family conferences (PFCs) and decision to withdraw life-sustaining treatment (DTW) on healthcare costs in an intensive care unit (ICU) setting is inconsistent. Methods: We retrospectively ... ...

Abstract	Background: Evidence regarding the impact of early palliative family conferences (PFCs) and decision to withdraw life-sustaining treatment (DTW) on healthcare costs in an intensive care unit (ICU) setting is inconsistent. Methods: We retrospectively analyzed patients who died in an ICU from 2013 to 2016. PFCs held within 7 days after ICU admission and DTWs were verified by reviewing medical records and claims data. Comparisons were first made between patients with and without DTWs, and secondly, between DTW patients with and without PFCs within 7 days. Propensity score matching methods were used to examine the difference in costs between patients with and without DTWs and PFCs within 7 days. Results: Of the 579 patients included, those with DTWs (n = 73) had a longer ICU stay than those without (n = 506) (12.9 ± 7.1 vs. 8.4 ± 9.6 days, p < 0.001). The DTW patients were more likely to have a “do-not-resuscitate” order (p < 0.001) and PFCs within 7 days (p < 0.001) and had lower healthcare costs (USD 7358 ± 4116 vs. 8669 ± 9,535, p = 0.038). After matching, healthcare cost reduction for patients with DTWs, compared with those without DTWs, was USD 3467 [95% CI, 915–6019] (p < 0.001). Compared with DTW patients without PFCs within 7 days, the costs for DTW patients with PFCs within 7 days further reduced to USD 3042 [95%CI, 1358–4725] (p < 0.001). Conclusion: Palliative family conferences held within 7 days after ICU admission with decisions to withdraw life-sustaining treatments significantly lowered healthcare costs. Keywords: Family meeting, Healthcare costs, Propensity score matching, Withdrawal of life-sustaining treatments
Keywords	Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Association of weaning preparedness with extubation outcome of mechanically ventilated patients in medical intensive care units

Feng-Ching Lin / Yao-Wen Kuo / Jih-Shuin Jerng / Huey-Dong Wu

PeerJ, Vol 8, p e

a retrospective analysis

2020 Volume 8973

Abstract: Background Assessment of preparedness of weaning has been recommended before extubation for mechanically ventilated patients. We aimed to understand the association of a structured assessment of weaning preparedness with successful liberation. Methods We ...

Abstract	Background Assessment of preparedness of weaning has been recommended before extubation for mechanically ventilated patients. We aimed to understand the association of a structured assessment of weaning preparedness with successful liberation. Methods We retrospectively investigated patients with acute respiratory failure who experienced an extubation trial at the medical intensive care units of a medical center and compared the demographic and clinical characteristics between those patients with successful and failed extubation. A composite score to assess the preparedness of weaning, the WEANSNOW score, was generated consisting of eight components, including Weaning parameters, Endotracheal tube, Arterial blood gas analysis, Nutrition, Secretions, Neuromuscular-affecting agents, Obstructive airway problems and Wakefulness. The prognostic ability of the WEANSNOW score for extubation was then analyzed. Results Of the 205 patients included, 138 (67.3%) patients had successful extubation. Compared with the failure group, the success group had a significantly shorter duration of MV before the weaning attempt (11.2 ± 11.6 vs. 31.7 ± 26.2 days, p < 0.001), more with congestive heart failure (42.0% vs. 25.4%, p = 0.020), and had different distribution of the types of acute respiratory failure (p = 0.037). The failure group also had a higher WEANSNOW score (1.22 ± 0.85 vs. 0.51 ± 0.71, p < 0.001) and worse Rapid Shallow Breathing Index (93.9 ± 63.8 vs. 56.3 ± 35.1, p < 0.001). Multivariate logistic regression analysis showed that a WEANSNOW Score = 1 or higher (OR = 2.880 (95% CI [1.291–6.426]), p = 0.010) and intubation duration >21 days (OR = 7.752 (95% CI [3.560–16.879]), p < 0.001) were independently associated with an increased probability of extubation failure. Conclusion Assessing the pre-extubation status of intubated patients in a checklist-based approach using the WEANSNOW score might provide valuable insights into extubation failure in patients in a medical ICU for acute respiratory failure. ...
Keywords	Respiratory failure ; Mechanical ventilation ; Endotracheal tube ; Weaning ; Extubation ; Preparedness ; Medicine ; R
Subject code	610
Language	English
Publishing date	2020-04-01T00:00:00Z
Publisher	PeerJ Inc.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Reinforcement of Tobacco Control and Reduction in Medical Utilization for Asthma in Taiwan

Huang-Ju Liang / Ming-Jiuan Wu / Jih-Shuin Jerng / Chiang-Hsing Yang

International Journal of Environmental Research and Public Health, Vol 16, Iss 20, p

A Population-Based Study

2019 Volume 3950

Abstract: Environmental air quality can affect asthma control and the development of overt asthmatic manifestations. In this population-based study, we investigated the effect of reinforcing a smoking ban in Taiwan through the enactment of the Tobacco Hazards and ... ...

Abstract	Environmental air quality can affect asthma control and the development of overt asthmatic manifestations. In this population-based study, we investigated the effect of reinforcing a smoking ban in Taiwan through the enactment of the Tobacco Hazards and Prevention Act (THPA) on healthcare utilization rate by asthmatics. Analysis was performed based on data relevant to non-hospitalized asthmatic patients with insurance claims between 2005 and 2013 from the National Health Insurance Research Database of Taiwan, reported data on Asian dust storms, and penalty rates for violations of the tobacco ban. Poisson regression showed that the risk for outpatient visits for asthma was lower after enactment of the THPA (RR = 0.98, 95% CI = 0.98−0.99), with a yearly trend of a reduced risk (RR = 0.99, 95% CI = 0.99−1.00), also lower in geographic regions with medium (RR = 0.79, 95% CI = 0.79−0.80) and high (RR = 0.91, 95% CI = 0.91−0.92) penalty rates. Subgroup analysis showed that asthma visit rates were reduced in both male and female groups after the enactment of the THPA. The risk of an asthma ER visit was increased after the enactment of the amended THPA (RR = 1.07, 95% CI = 1.05−1.09), although the yearly trend was not significant (RR = 1.00, 95% CI = 1.00−1.00). The risk of emergency room visits for asthma was significantly reduced in regions with medium (RR = 0.68, 95% CI = 0.68−0.69) and high (RR = 0.75, 95% CI = 0.74−0.76) penalty rates. Subgroup analysis showed that the visit rates were similar in both male and female groups. The effectiveness of reinforcing the smoking ban warrants further policies aimed at further reducing passive smoking.
Keywords	tobacco ban ; smoking ; asthma ; healthcare utilization ; Medicine ; R
Subject code	910
Language	English
Publishing date	2019-10-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Automatic tube compensation for liberation from prolonged mechanical ventilation in tracheostomized patients

Chia-Hao Wu / Feng-Ching Lin / Jih-Shuin Jerng / Ming-Hann Shin / Yi-Chia Wang / Cheng-Jun Lee / Li-Min Lin / Nai-Hua Lin / Yao-Wen Kuo / Shih-Chi Ku / Huey-Dong Wu

Journal of the Formosan Medical Association, Vol 122, Iss 11, Pp 1132-

A retrospective analysis

2023 Volume 1140

Abstract: Background: To analyze the predictability of an automatic tube compensation (ATC) screening test compared with the conventional direct liberation test performed before continuous oxygen support for MV liberation. Methods: This retrospective study ... ...

Abstract	Background: To analyze the predictability of an automatic tube compensation (ATC) screening test compared with the conventional direct liberation test performed before continuous oxygen support for MV liberation. Methods: This retrospective study analyzed tracheostomized patients with prolonged MV in a weaning unit of a medical center in Taiwan. In March 2020, a four-day ATC test to screen patient eligibility for ventilator liberation was implemented, intended to replace the direct liberation test. We compared the predictive accuracy of these two screening methods on the relevant outcomes in the two years before and one year after the implementation of this policy. Results: Of the 403 cases, 246 (61%) and 157 (39%) received direct liberation and ATC screening tests, respectively. These two groups had similar outcomes: successful weaning upon leaving the Respiratory Care Center (RCC), success on day 100 of MV, success at hospital discharge, and in-hospital survival. Receiver operating characteristic curve analysis showed that the ATC screening test had better predictive ability than the direct liberation test for RCC weaning, discharge weaning, 100-day weaning, and in-hospital survival. Conclusion: This closed-circuit ATC screening test before ventilator liberation is a feasible and valuable method for screening PMV patients undergoing ventilator liberation in the pandemic era. Its predictability for a comparison with the open-circuit oxygen test requires further investigation.
Keywords	Mechanical ventilation ; Tracheostomy ; Tube compensation ; Weaning ; Medicine (General) ; R5-920
Subject code	150
Language	English
Publishing date	2023-11-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Improving the Process of Shared Decision-Making by Integrating Online Structured Information and Self-Assessment Tools

Pei-Jung Hsu / Chia-Ying Wu / Lu-Cheng Kuo / Ming-Yuan Chen / Yu-Ling Chen / Szu-Fen Huang / Pao-Yu Chuang / Jih-Shuin Jerng / Shey-Ying Chen

Journal of Personalized Medicine, Vol 12, Iss 256, p

2022 Volume 256

Abstract: The integration of face-to-face communication and online processes to provide access to information and self-assessment tools may improve shared decision-making (SDM) processes. We aimed to assess the effectiveness of implementing an online SDM process ... ...

Abstract	The integration of face-to-face communication and online processes to provide access to information and self-assessment tools may improve shared decision-making (SDM) processes. We aimed to assess the effectiveness of implementing an online SDM process with topics and content developed through a participatory design approach. We analyzed the triggered and completed SDM cases with responses from participants at a medical center in Taiwan. Data were retrieved from the Research Electronic Data Capture (REDCap) database of the hospital for analysis. Each team developed web-based patient decision aids (PDA) with empirical evidence in a multi-digitized manner, allowing patients to scan QR codes on a leaflet using their mobile phones and then read the PDA content online. From July 2019 to December 2020, 48 web-based SDM topics were implemented in the 24 clinical departments of this hospital. The results showed that using the REDCap system improved SDM efficiency and quality. Implementing an online SDM process integrated with face-to-face communication enhanced the practice and effectiveness of SDM, possibly through the flexibility of accessing information, self-assessment, and feedback evaluation.
Keywords	shared decision-making ; patient decision aids ; digital patient–provider communication tool ; Medicine ; R
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Maximal expiratory pressure is associated with reinstitution of mechanical ventilation after successful unassisted breathing trials in tracheostomized patients with prolonged mechanical ventilation.

Shwu-Jen Lin / Jih-Shuin Jerng / Yao-Wen Kuo / Chao-Ling Wu / Shih-Chi Ku / Huey-Dong Wu

PLoS ONE, Vol 15, Iss 3, p e

2020 Volume 0229935

Abstract: OBJECTIVE:Reinstitution of mechanical ventilation (MV) for tracheostomized patients after successful weaning may occur as the care setting changes from critical care to general care. We aimed to investigate the occurrence, consequence and associated ... ...

Abstract	OBJECTIVE:Reinstitution of mechanical ventilation (MV) for tracheostomized patients after successful weaning may occur as the care setting changes from critical care to general care. We aimed to investigate the occurrence, consequence and associated factors of MV reinstitution. METHODS:We analyzed the clinical data and physiological measurements of tracheostomized patients with prolonged MV discharged from the weaning unit to general wards after successful weaning to compare between those with and without in-hospital MV reinstitution within 60 days. RESULTS:Of 454 patients successfully weaned, 116 (25.6%) reinstituted MV at general wards within 60 days; at hospital discharge, 42 (36.2%) of them were eventually liberated from MV, 51 (44.0%) remained MV dependent, and 33 (28.4%) died. Of the 338 patients without reinstitution within 60 days, only 3 (0.9%) were later reinstituted with MV before discharge (on day 67, 89 and 136 at general wards, respectively), and 322 (95.2%) were successfully weaned again at discharge, while 13 (3.8%) died. Patients with MV reinstitution had a significantly lower level of maximal expiratory pressure (PEmax) before unassisted breathing trial compared to those without reinstitution. Multivariable Cox regression analysis showed fever at RCC discharge (hazard ratio [HR] 14.00, 95% confidence interval [CI] 3.2-61.9) chronic obstructive pulmonary disease (HR 2.37, 95% CI 1.34-4.18), renal replacement therapy at the ICU (HR 2.29, 95% CI 1.50-3.49) and extubation failure before tracheostomy (HR 1.76, 95% CI 1.18-2.63) were associated with increased risks of reinstitution, while PEmax > 30 cmH2O (HR 0.51, 95% CI 0.35-0.76) was associated with a decreased risk of reinstitution. CONCLUSIONS:The reinstitution of MV at the general ward is significant, with poor outcomes. The PEmax measured before unassisted breathing trial was significantly associated with the risk of reinstituting MV at the general wards.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Time to have a paradigm shift in health care quality measurement

Kuan-Yu Hung / Jih-Shuin Jerng

Journal of the Formosan Medical Association, Vol 113, Iss 10, Pp 673-

2014 Volume 679

Abstract: Quality measurement is important to stakeholders in providing valid information for improvement, and has been associated with hospital accreditation in most countries. The commonly used categories of indicators are structure, process, and outcome. ... ...

Abstract	Quality measurement is important to stakeholders in providing valid information for improvement, and has been associated with hospital accreditation in most countries. The commonly used categories of indicators are structure, process, and outcome. Outcome indicators are of foremost importance as they reflect the effect of health care; structure indicators are commonly used for assessing capacities or facilities available for providing services, whereas process indicators assess how well the service is delivered, and provide essential and important information for quality improvement. For a process indicator to be valid, it should be linked to an outcome, whereas a structure indicator must be linked to a better outcome. Although there are no strict rules for usage or selection of indicators, it is important to ensure adequate coverage of relevant domains of the health care services intended to be evaluated. Because the trends in health care services and management are changing, it is time to have a paradigm shift in health care quality measurement. Although evaluating the quality had also been extended to include quality of life and patient satisfaction, the ultimate aim of health care services should be “staying healthy, getting healthy, and living healthy”. It is important for physicians to learn how to use these clinical indicators for improving service performance and organizational growth.
Keywords	health care ; indicator ; outcome ; process ; quality improvement ; quality measurement ; structure ; Medicine (General) ; R5-920
Subject code	360
Language	English
Publishing date	2014-10-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Quality gaps and priorities for improvement of healthcare service for patients with prolonged mechanical ventilation in the view of family

Bao-Lin Chang / Hsiu-O Kao / Shwu-Jen Lin / Shu-Hui Yang / Yao-Wen Kuo / Jih-Shuin Jerng

Journal of the Formosan Medical Association, Vol 118, Iss 5, Pp 922-

2019 Volume 931

Abstract: Background: Little is known about the gaps between expectation and the perception of service quality in the care setting of prolonged mechanical ventilation (MV). Methods: We conducted this prospective study at the Respiratory Care Center (RCC) of a ... ...

Abstract	Background: Little is known about the gaps between expectation and the perception of service quality in the care setting of prolonged mechanical ventilation (MV). Methods: We conducted this prospective study at the Respiratory Care Center (RCC) of a medical center from February 2017 to January 2018. Family members of the patients admitted to the RCC completed a questionnaire based on the SERVQUAL instrument in two sections – expectation and perception, consisting of 22 questions each in five dimensions. We analyzed the gaps between paired items, used important-performance analysis (IPA) to identify priority items for improvement, and performed multivariate logistic regression analysis. Results: A total of 167 respondents participated in the survey. The average length of patient stay in the RCC was 19.4 days, and 70.7% were successfully liberated from MV. The overall mean SERVQUAL scores for the two sections were similar (4.50 ± 0.52 and 4.51 ± 0.54 for expectation and perception, respectively; p = 0.808). IPA identified four items, including one “tangible,” one “reliability” and two “empathy” with an undesired expectation/perception gap indicating a priority for improvement. Multivariate logistic regression analysis showed that male respondents, patients older than 75 years, tracheostomy, and the need for physical training or dialysis were associated with an increased gap in these priority items. Conclusion: Gaps exist between expectation and perception in multiple dimensions of the quality of healthcare service in the care setting of prolonged MV, indicating unmet needs and priorities for improvement. Keywords: Respiratory care center, Service quality, Satisfaction, Gap, Expectation, Perception
Keywords	Medicine (General) ; R5-920
Subject code	310
Language	English
Publishing date	2019-05-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Kinetics of oxygen uptake during unassisted breathing trials in prolonged mechanical ventilation

I-Hsien Lee / Yao-Wen Kuo / Feng-Ching Lin / Chang-Wei Wu / Jih-Shuin Jerng / Ping-Hung Kuo / Jui-Chen Cheng / Ying-Chun Chien / Chun-Kai Huang / Huey-Dong Wu

Scientific Reports, Vol 10, Iss 1, Pp 1-

a prospective pilot study

2020 Volume 10

Abstract: Abstract Few studies have investigated the measurement of oxygen uptake ( $${\dot{\text{V}}}$$ V ˙ O2) in tracheostomized patients undergoing unassisted breathing trials (UBTs) for liberation from mechanical ventilation (MV). Using an open-circuit, ... ...

Abstract	Abstract Few studies have investigated the measurement of oxygen uptake ( $${\dot{\text{V}}}$$ V ˙ O2) in tracheostomized patients undergoing unassisted breathing trials (UBTs) for liberation from mechanical ventilation (MV). Using an open-circuit, breath-to-breath method, we continuously measured $${\dot{\text{V}}}$$ V ˙ O2 and relevant parameters during 120-min UBTs via a T-tube in 49 tracheostomized patients with prolonged MV, and calculated mean values in the first and last 5-min periods. Forty-one (84%) patients successfully completed the UBTs. The median $${\dot{\text{V}}}$$ V ˙ O2 increased significantly (from 235.8 to 298.2 ml/min; P = 0.025) in the failure group, but there was no significant change in the success group (from 223.1 to 221.6 ml/min; P = 0.505). In multivariate logistic regression analysis, an increase in $${\dot{\text{V}}}$$ V ˙ O2 > 17% from the beginning period (odds ratio [OR] 0.084; 95% confidence interval [CI] 0.012–0.600; P = 0.014) and a peak inspiratory pressure greater than − 30 cmH2O (OR 11.083; 95% CI 1.117–109.944; P = 0.04) were significantly associated with the success of 120-min UBT. A refined prediction model combining heart rate, energy expenditure, end-tidal CO2 and oxygen equivalent showed a modest increase in the area under the receiver operating characteristic curve of 0.788 (P = 0.578) and lower Akaike information criterion score of 41.83 compared to the traditional prediction model including heart rate and respiratory rate for achieving 48 h of unassisted breathing. Our findings show the potential of monitoring $${\dot{\text{V}}}$$ V ˙ O2 in the final phase of weaning in tracheostomized patients with prolonged MV.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2020-08-01T00:00:00Z
Publisher	Nature Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: In-Hospital Patient Safety Events, Healthcare Costs and Utilization

Yao-Wen Kuo / Jih-Shuin Jerng / Chia-Kuei Lin / Hsiao-Fang Huang / Li-Chin Chen / Yu-Tzu Li / Szu-Fen Huang / Kuan-Yu Hung

Healthcare, Vol 8, Iss 388, p

An Analysis from the Incident Reporting System in an Academic Medical Center

2020 Volume 388

Abstract: The possible association of patient safety events (PSEs) with the costs and utilization remains a concern. In this retrospective analysis, we investigated adult hospitalizations at a medical center between 2010 and 2015 with or without reported PSEs. ... ...

Abstract	The possible association of patient safety events (PSEs) with the costs and utilization remains a concern. In this retrospective analysis, we investigated adult hospitalizations at a medical center between 2010 and 2015 with or without reported PSEs. Administrative and claims data were analyzed to compare the costs and length of stay (LOS) between cases with and without PSEs of the three most common categories during the first 14 days of hospitalization. Two models, including linear regression and propensity score-matched comparison, were performed for each reference day group of hospitalizations. Of 14,181 PSEs from 424,635 hospitalizations, 69.8% were near miss or no-harm events. Costs and LOS were similar between fall cases and controls in all of the 14 reference days. In contrast, for cases of tube and line events and controls, there were consistent differences in costs and LOS in the majority of the reference days (86% and 57%, respectively). Consistent differences were less frequently seen for medication events and control events (36% and 43%, respectively). Our study approach of comparing cases with PSEs and those without any PSE showed significant differences in costs and LOS for tube and line events, and medication events. No difference in cost or LOS was found regarding fall events. Further studies exploring adjustments for event risks and harm-oriented analysis are warranted.
Keywords	patient safety events ; incident reporting ; healthcare cost ; utilization ; Medicine ; R
Subject code	333
Language	English
Publishing date	2020-10-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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