A Cost Analysis of Pediatric Tracheostomy and Chronic Ventilation

Wednesday, March 6, 2019, 12:00 AM - Thursday, March 5, 2020, 12:00 AM

Pediatric Grand Rounds

1. Describe the pathway to discharge on home mechanical ventilation;
2. Describe patient factors associated with high hospital costs; and
3. Describe hospital factors associated with high hospital costs.

Accreditation Statement

In support of improving patient care, Indiana University School of Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physicians

Indiana University School of Medicine designates this enduring activity for a maximum of 1.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

References for this presentation: 

 1. Benneyworth BD, Gebremariam A, Clark SJ, Shanley TP, Davis MM. Inpatient health care utilization for children dependent on long-term mechanical ventilation. Pediatrics. 2011;127(6):e1533-e41.

 2. Chau SK, Yung AW, Lee SL. Long-Term Management for Ventilator-Assisted Children in Hong Kong: 2 Decades' Experience. Respiratory care. 2017;62(1):54-64. Epub 2016/12/03. doi: 10.4187/respcare.04989. PubMed PMID: 27899532.

 3. Amin RS, Fitton CM. Tracheostomy and home ventilation in children. Seminars in Neonatology.8(2):127-35. PubMed PMID: 15001149.

 4. Watters K, O'Neill M, Zhu H, Graham RJ, Hall M, Berry J. Two-year mortality, complications, and healthcare use in children with medicaid following tracheostomy. Laryngoscope.126(11):2611-7. PubMed PMID: 27060012.

 5. Reiter K, Pernath N, Pagel P, Hiedi S, Hoffmann F, Schoen C, et al. Risk factors for morbidity and mortality in pediatric home mechanical ventilation. Clinical Pediatrics.50(3):237-43. PubMed PMID: 21127085.

 6. Fields AI. Pediatric tracheostomy: the great liberator or the last battlefield? Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2008;9(1):126-7. Epub 2008/01/11. doi: 10.1097/01.pcc.0000298655.36899.4a. PubMed PMID: 18185130.

 7. Messineo A, Giusti F, Narne S, Mognato G, Antoniello L, Guglielmi M. The safety of home tracheostomy care for children. Journal of Pediatric Surgery.30(8):1246-8. PubMed PMID: 7472995.

 8. Meier JD, Valentine KJ, Hagedorn C, Hartling C, Gershan W, Muntz HR, et al. Emergency department use among children with tracheostomies: Avoidable visits. Journal of pediatric rehabilitation medicine. 2015;8(2):105-11. Epub 2015/09/28. doi: 10.3233/prm-150324. PubMed PMID: 26409864.

 9. Wilcox LJ, Weber BC, Cunningham TD, Baldassari CM. Tracheostomy Complications in Institutionalized Children with Long-term Tracheostomy and Ventilator Dependence. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2016;154(4):725-30. Epub 2016/02/18. doi: 10.1177/0194599816628486. PubMed PMID: 26884369.

 10. Hsia SH, Lin JJ, Huang IA, Wu CT. Outcome of long-term mechanical ventilation support in children. Pediatrics & Neonatology.53(5):304-8. PubMed PMID: 23084723.

 11. Kun SS, Edwards JD, Ward SL, Keens TG. Hospital readmissions for newly discharged pediatric home mechanical ventilation patients. Pediatric pulmonology. 2012;47(4):409-14. Epub 2011/09/09. doi: 10.1002/ppul.21536. PubMed PMID: 21901855; PubMed Central PMCID: PMCPMC3694986.

 12. Graf JM, Montagnino BA, Hueckel R, McPherson ML. Pediatric tracheostomies: a recent experience from one academic center. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2008;9(1):96-100. Epub 2008/05/15. doi: 10.1097/01.pcc.0000298641.84257.53. PubMed PMID: 18477921.

 13. Sobotka SA, Hird-McCorry LP, Goodman DM. Identification of Fail Points for Discharging Pediatric Patients With New Tracheostomy and Ventilator. Hospital pediatrics.6(9):552-7. PubMed PMID: 27538680.

 14. Cristea AI, Ackerman VL, Davis SD, Carroll AE, Downs SM, Yu Z, et al. Median Household Income: Association with Mortality in Children on Chronic Ventilation at Home Secondary to Bronchopulmonary Dysplasia. Pediatric allergy, immunology, and pulmonology. 2015;28(1):41-6. Epub 2015/04/09. doi: 10.1089/ped.2014.0406. PubMed PMID: 25852968; PubMed Central PMCID: PMCPMC4365512.

 15. McPherson ML, Shekerdemian L, Goldsworthy M, Minard CG, Nelson CS, Stein F, et al. A decade of pediatric tracheostomies: Indications, outcomes, and long-term prognosis. Pediatric pulmonology. 2017;52(7):946-53. Epub 2017/03/07. doi: 10.1002/ppul.23657. PubMed PMID: 28263440.

 16. Dursun O, Ozel D. Early and long-term outcome after tracheostomy in children. Pediatrics international : official journal of the Japan Pediatric Society. 2011;53(2):202-6. Epub 2010/07/30. doi: 10.1111/j.1442-200X.2010.03208.x. PubMed PMID: 20667029.

 17. Spentzas T, Auth M, Hess P, Minarik M, Storgion S, Stidham G. Natural course following pediatric tracheostomy. Journal of intensive care medicine. 2010;25(1):39-45. Epub 2010/01/23. doi: 10.1177/0885066609350874. PubMed PMID: 20095079.

 18. Edwards JD, Kun SS, Keens TG. Outcomes and causes of death in children on home mechanical ventilation via tracheostomy: an institutional and literature review. The Journal of pediatrics. 2010;157(6):955-9 e2. Epub 2010/08/18. doi: 10.1016/j.jpeds.2010.06.012. PubMed PMID: 20713294.

 19. Cristea AI, Carroll AE, Davis SD, Swigonski NL, Ackerman VL. Outcomes of children with severe bronchopulmonary dysplasia who were ventilator dependent at home. Pediatrics. 2013;132(3):e727-34. Epub 2013/08/07. doi: 10.1542/peds.2012-2990. PubMed PMID: 23918888; PubMed Central PMCID: PMCPMC3876749.

 20. Graham RJ, McManus ML, Rodday AM, Weidner RA, Parsons SK. Pediatric Specialty Care Model for Management of Chronic Respiratory Failure: Cost and Savings Implications and Misalignment With Payment Models. Pediatric Critical Care Medicine. 9000;Publish Ahead of Print. doi: 10.1097/pcc.0000000000001472. PubMed PMID: 00130478-900000000-98495.

 21. Baker CD, Martin S, Thrasher J, Moore HM, Baker J, Abman SH, et al. A Standardized Discharge Process Decreases Length of Stay for Ventilator-Dependent Children. Pediatrics. 2016;137(4). Epub 2016/03/12. doi: 10.1542/peds.2015-0637. PubMed PMID: 26966133; PubMed Central PMCID: PMCPMC4811306.

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AMA PRA Category 1 Credits™ (1.00 hours), Non-Physician Attendance (1.00 hours)

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