Ventilator-Associated Pneumonia Among the Elderly In Long-Term Care Hospitals: 2005 - 2010

Ventilator-associated pneumonia (VAP) refers to nosocomial pneumonia occurring in patients receiving mechanical ventilation. It is a common complication of care that often produces excess (and likely avoidable) length of stay, mortality and treatment costs. While several studies have examined the effects of VAP in inpatient facilities, the incidence and outcomes of VAP in post acute settings have not been examined. Long-term Care Hospitals (LTCHs) provide post-acute ventilator care for many Medicare beneficiaries with complex conditions requiring long stays. Control of VAP is an important aspect of quality of care improvement for these facilities. MEDPAR discharge data for LTCHs (CY 2005-2010) are examined for Medicare fee-for-service beneficiaries with a procedure code of 96.72 (continuous mechanical ventilation for 96 consecutive hours or more) (N=13,759). Patients with a diagnosis of ICD-9-CM codes 481.xx – 486.xx were classified as having VAP. The percent of Medicare LTCH ventilator patients with VAP increased from 25.9% to 30% from 2005 to 2010. The average age of patients with and without VAP was similar (71 - 72 years). Length of stay, total covered charges and percent of patients discharged to skilled nursing facilities were higher for VAP patients than for ventilator patients without VAP during the study period. The percent of patients dying in hospital was not different for VAP and non-VAP patients. The high rate of ventilator patients with VAP and their excess length of stay and costs to Medicare indicate that VAP control interventions common in acute care hospitals should also be implemented in LTCHs.