Abstract
RATIONALE: Mechanically ventilated patients require complex care and are at high risk for rehospitalization, but different systems of care may result in different hospital discharge practices and rates of rehospitalization. OBJECTIVES: To compare lengths of hospitalization, discharge patterns, and rehospitalization rates in New York in the United States and Ontario in Canada. METHODS: We conducted a retrospective cohort study of mechanically ventilated patients who survived an acute care hospitalization in New York or Ontario from 2010 to 2012, using linkable administrative healthcare data. RESULTS: The primary outcome was the cumulative incidence of first rehospitalization within 30 days of discharge, accounting for the competing risk of death. Of 71,063 mechanically ventilated patients in New York, and 41,875 in Ontario who survived to hospital discharge, median length of initial hospital stay was similar in New York and Ontario (15 d, interquartile range = 8-28 vs. 16 d [9-30]), but was systematically shorter in New York when stratified by patient subgroups of different illness severity. Fewer patients in New York were discharged directly home (53.6% vs. 71.4%). Of patients in New York, 15,527 (cumulative incidence 21.9%) had a first rehospitalization within 30 days versus 5,580 (cumulative incidence 13.3%) in Ontario (P < 0.001). Incidence of rehospitalization was higher in New York across all subgroups assessed, with the greatest differences among patients with a tracheostomy (29.8% vs. 13.3%, P < 0.001), those who received dialysis during the hospitalization (31.9% vs. 17.4%, P < 0.001), and for patients not discharged directly home (27.6% vs. 13.3%, P < 0.001). CONCLUSIONS: Care patterns for mechanically ventilated patients in New York and Ontario are very different; mechanically ventilated patients who survive to hospital discharge in New York have shorter hospital stays, with higher rehospitalization rates within 30 days compared with Ontario.