August 2020 PA Health Care Cost Mechanical Ventilation in PA Hospitals—Pre-COVID-19 Containment Council . oo . . . i The COVID-19 pandemic has highlighted the important role mechanical ventilators play in the management of severe respiratory illness. A mechanical ventilator is a machine that does the work of breathing for a patient by delivering oxygen into the __ lungs and helping to remove carbon dioxide. Mechanical ventilators may be used to hesearcil treat critical illnesses such as acute respiratory failure, sepsis and severe pneumonia o or in conditions where a patient can no longer safely breathe independently (e.g., ath \\ drug overdose). PHC4 examined this important life-saving treatment modality to serve as a baseline for future analyses on hospitalizations involving the novel coronavirus responsible for the infectious respiratory illness seen during the COVID-19 pandemic. This brief includes hospitalizations involving a mechanical ventilator for patients discharged from Pennsylvania general acute care hospitals in fiscal year (FY) 2019: July 1, 2018 through June 30, 2019. iN O There were 46,257 hospitalizations involving mechanical ventilation in FY 2019 (nearly 3% of all hospitalizations that year). OC) Hospitalizations involving mechanical ventilation occur most often for adult patients with critical illnesses such as acute respiratory failure, sepsis and severe pneumonia. For patients less than age 18, mechanical ventilation is used most often to treat premature or low birth weight newborns. Hospitalization Rates Involving Mechanical Ventilation per 10,000 Pennsylvania Residents Statewide Rate: 33.4 In general, population-based data showed higher hospitalization rates* involving mechanical ventilation among older residents, black (non-Hispanic) residents, residents living in higher poverty areas and male residents. These characteristics are similar to those believed to be at higher risk of developing serious illness from COVID-19. Age Race/Ethnicity Age less than 18.............+ 14.2 Black (non-Hispanic)............. 53.2 AGC 18-44 ooo... .eeeecceeseeeeees 13.6 White (non-Hispanic) ........... 31.7 Age 45-64..........ceceseeseereeee 39.2 HISPANIC .....eeececeeeeeeeeeeeeeeeees 16.8 Age 65-84.........ccceeessrereeee 82.0 Age 85 and older.............. 91.1 Poverty* Female/Male High Poverty..........csscceee 49.6 Ve) (er 37.5 Low Poverty .............ssseeee 26.8 FEMAIE........ccesccceestecessteeessnees 29.4 * Rates are based on Pennsylvania residents only (42,760 hospitalizations or 92% of all mechanical ventilation cases) and US Census Bureau data. t High Poverty: Residents living in areas where 25% or more of the population lives in poverty. Low Poverty: Residents living in areas with <10% of the population living in poverty (2018 US Census Bureau estimates at the zip code level). PHS Pennsylvania Health Care Cost Containment Council 1 @ Patients on mechanical ventilation stayed in the hospital an average of 12.6 days compared to an average of 4.6 days for all other patients. The in-hospital mortality rate for patients on mechanical ventilation was 25.9% compared to the rate of 1.1% for all other patients. @ 34.1% of patients on mechanical ventilation were transferred to skilled nursing, rehab, long-term care, or other acute care facilities after discharge from the hospital compared to 16.7% for all other patients. Mechanical Ventilation and Infectious Pheumonia Approximately 23.7% of the adult patients on mechanical ventilation had, at the time of admission, a diagnosis of infectious pneumonia—an infection of one or both lungs caused by organisms such as bacteria and viruses. The novel coronavirus responsible for COVID-19 can also infect the lungs and cause pneumonia and acute respiratory disease. Future analysis comparing the rates of mechanical ventilator use for patients with infectious pneumonia versus those with COVID-19 related pneumonia can provide insight into the severity of illness associated with each type of pneumonia. e 93.9% of adult patients on mechanical ventilation with a diagnosis of infectious pneumonia had at least one serious underlying condition (e.g., heart failure, compromised immune system, chronic lung diseases, etc.) with 73.9% of these patients having more than one serious underlying condition—information that will be important in future COVID-19 analysis as patients with these conditions are thought to be at greater risk of developing a more severe case of COVID-19 related pneumonia. e 26.7% of adult patients on mechanical ventilation with a diagnosis of infectious pneumonia died in the hospital. e 12.5 days was the average length of stay for these hospitalizations. About PHC4 Created by the PA General Assembly in 1986, the PA Health Care Cost Containment Council (PHC4) is an independent state agency charged with collecting, analyzing and reporting information that can be used to improve the quality and restrain the cost of health care in the state. Today, PHC4 is a recognized national leader in public health care reporting. PHC4 is governed by a board of directors representing business, labor, consumers, health care providers, insurers and state government. Joe Martin, Executive Director 225 Market Street, Suite 400, Harrisburg, PA 17101 717-232-6787 - www.phc4.org er Pennsylvania Health Care Cost Containment Council 2 Hospitalizations Involving Mechanical Ventilation by County, FY 2019 Rates are based on Pennsylvania residents only (42,760 hospitalizations or 92% of all mechanical ventilation cases). Total Number of Rate per 10,000 Total Number of Rate per 10,000 Hospitalizations Residents Hospitalizations Residents Statewide 42,760 33.4 Juniata 63 25.5 Adams 272 26.5 Lackawanna 828 39.3 Allegheny 3,821 31.4 Lancaster 1,214 22.3 Armstrong 212 32.5 Lawrence 353 41.0 Beaver 675 41.0 Lebanon 438 31.0 Bedford 163 33.8 Lehigh 920 25.0 Berks 1,039 24.7 Luzerne 1,429 45.0 Blair 542 44.2 Lycoming 364 32.0 Bradford 163 26.8 McKean 106 25.9 Bucks 1,971 31.4 Mercer 429 38.8 Butler 434 23.1 Mifflin 143 30.9 Cambria 630 47.8 Monroe 572 33.7 Cameron 35 77.9 Montgomery 2,521 30.4 Carbon 249 38.8 Montour 63 34.5 Centre 252 15.5 Northampton 912 29.9 Chester 959 18.4 Northumberland 326 35.8 Clarion 122 31.5 Perry 139 30.1 Clearfield 315 39.7 Philadelphia 7,564 47.7 Clinton 96 24.8 Pike 109 19.5 Columbia 238 36.4 Potter 53 31.9 Crawford 319 37.5 Schuylkill 614 43.2 Cumberland 743 29.6 Snyder 131 32.3 Dauphin 907 32.7 Somerset 245 33.1 Delaware 1,919 34.0 Sullivan 28 46.1 Elk 108 35.8 Susquehanna 75 18.5 Erie 1,071 39.4 Tioga 111 27.2 Fayette 579 44.4 Union 88 19.6 Forest 17 23.4 Venango 187 36.5 Franklin 496 32.0 Warren 118 29.9 Fulton 48 33.1 Washington 681 32.8 Greene 78 21.4 Wayne 154 30.0 Huntingdon 105 23.2 Westmoreland 1,431 40.8 Indiana 299 35.4 Wyoming 108 39.9 Jefferson 178 40.8 York 1,188 26.5 er Pennsylvania Health Care Cost Containment Council 3