Over the past two decades, tracheostomy use rose substantially in the United States until 2008, when use began to decline. The observed dramatic increase in discharge of tracheostomy patients to long-term care facilities may have significant implications for clinical care, healthcare costs, policy, and research. Future studies should include long-term facilities when analyzing outcomes of tracheostomy.

Purpose Epidemiological trends for invasive mechanical ventilation (IMV) have not been clearly defined. We sought to define trends for IMV in the US and assess for disease-specific variation for three common causes of respiratory failure: pneumonia, heart failure (HF), and chronic obstructive pulmonary disease (COPD). Methods We calculated national estimates for utilization of non-surgical IMV cases from the Nationwide Inpatient Sample from 1993-2009 and compared trends for COPD, HF, and pneumonia. Results We identified 8,309,344 cases of IMV from 1993-2009. Utilization of IMV for non-surgical indications increased from 178.9/100,000 in 1993 to 310.9/100,000 US adults in 2009. Pneumonia cases requiring IMV showed the largest increase (103.6%), whereas COPD cases remained relatively stable (2.5% increase) and HF cases decreased by 55.4%. Similar demographic and clinical changes were observed for pneumonia, COPD, and HF, with cases of IMV becoming younger, more ethnically diverse, and more frequently insured by Medicaid. Outcome trends for patients differed based on diagnosis. Adjusted hospital mortality decreased over time for cases of pneumonia (OR per 5 years=0.89, 95% CI 0.88-0.90) and COPD (OR per 5 years=0.97, 95% CI 0.97-0.98) but increased for HF (OR per 5 years=1.10, 95% CI 1.09-1.12). Conclusion Utilization of IMV in the US increased from 1993-2009 with a decrease in overall mortality. However, trends in utilization and outcomes of IMV differed markedly based on diagnosis. Unlike favorable outcome trends in pneumonia and COPD, hospital mortality for HF has not improved. Further studies to investigate the outcome gap between HF and other causes of respiratory failure are needed.

OBJECTIVES Patients with congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) account for most 30‐day hospital readmissions nationwide. The Coordinated‐Transitional Care (C‐TraC) program is a telephone‐based, nurse‐driven intervention shown to decrease readmissions in Veterans Affairs (VA) and non‐VA hospitals. The goal of this project was to assess the feasibility and efficacy of adapting C‐TraC to meet the needs of complex patients with CHF and COPD in a large urban tertiary care VA medical center. DESIGN We used the Replicating Effective Programs model to guide the implementation. The C‐TraC nurse received intensive training in cardiology and pulmonology and worked closely with both inpatient and outpatient providers to coordinate care. Eligible patients were admitted with CHF or COPD and had at least one additional risk for readmission. SETTING The nurse met patients in the hospital, participated in their discharge planning, and then provided intensive case management for up to 4 weeks. PARTICIPANTS Over its initial 14 months, the program successfully enrolled 299 veterans with good fidelity to the protocol. MEASUREMENTS A total of 43 (15.8%) C‐TraC participants were rehospitalized within 30 days compared with 172 (21.0%) of historical controls matched 3:1 on age, risk of 90‐day hospital admission, and discharge diagnosis. RESULTS Participants were 54% less likely to be rehospitalized (odds ratio = .46; 95% CI = .24‐.89). CONCLUSION The program was financially sustainable. The total cost of care in the 30‐day postdischarge period was $1842.52 less per C‐TraC patient than per controls, leading the medical center to sustain and expand the program.