{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T20:03:56Z","timestamp":1791057836697,"version":"4.1.0"},"reference-count":34,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2013,11,1]],"date-time":"2013-11-01T00:00:00Z","timestamp":1383264000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respir Care"],"published-print":{"date-parts":[[2013,11]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Tracheostomy practice in patients with acute respiratory failure (ARF) varies greatly among institutions. This variability has the potential to be reflected in the resources expended providing care. In various healthcare environments, increased resource expenditure has been associated with a favorable effect on outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE:<\/jats:title>\n                    <jats:p>To examine the association between institutional resource expenditure and mortality in ARF patients managed with tracheostomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We developed analytic models employing the University Health Systems Consortium (Oakbrook, Illinois) database. Administrative coding data were used to identify patients with the principal diagnosis of ARF, procedures, complications, post-discharge destination, and survival. Mean resource intensity of participating academic medical centers was determined using risk-adjusted estimates of costs. Mortality risk was determined using a multivariable approach that incorporated patient-level demographic and clinical variables and institution-level resource intensity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      We analyzed data from 44,124 ARF subjects, 4,776 (10.8%) of whom underwent tracheostomy. Compared to low-resource-intensity settings, treatment in high-resource-intensity academic medical centers was associated with increased risk of mortality (odds ratio 1.11, 95% CI 1.05\u20131.76), including those managed with tracheostomy (odds ratio high-resource-intensity academic medical center with tracheostomy 1.10, 95% CI 1.04\u20131.17). We examined the relationship between complication development and outcome. While neither the profile nor number of complications accumulated differed comparing treatment environments (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt; .05 for both), mortality for tracheostomy patients experiencing complications was greater in high-resource-intensity (95\/313, 30.3%) versus low-resource-intensity (552\/2,587, 21.3%) academic medical centers (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>We were unable to demonstrate a positive relationship between resource expenditure and outcome in ARF patients managed with tracheostomy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4187\/respcare.02359","type":"journal-article","created":{"date-parts":[[2013,5,1]],"date-time":"2013-05-01T11:29:29Z","timestamp":1367407769000},"page":"1863-1872","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":17,"title":["High Resource Utilization Does Not Affect Mortality in Acute Respiratory Failure Patients Managed With Tracheostomy"],"prefix":"10.1177","volume":"58","author":[{"given":"Bradley D","family":"Freeman","sequence":"first","affiliation":[{"name":"Department of Surgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dustin","family":"Stwalley","sequence":"additional","affiliation":[{"name":"Center for Economic Evaluation in Medicine, Washington University School of Medicine, St Louis, Missouri."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis","family":"Lambert","sequence":"additional","affiliation":[{"name":"Center for Economic Evaluation in Medicine, Washington University School of Medicine, St Louis, Missouri."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Edler","sequence":"additional","affiliation":[{"name":"Center for Economic Evaluation in Medicine, Washington University School of Medicine, St Louis, Missouri."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter E","family":"Morris","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Wake Forest University Health Sciences Center, Wake Forest, North Carolina."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Medvedev","sequence":"additional","affiliation":[{"name":"University Health Systems Consortium, Oakbrook, Illinois."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel F","family":"Hohmann","sequence":"additional","affiliation":[{"name":"University Health Systems Consortium, Oakbrook, Illinois."},{"name":"Department of Health Systems Management, Rush University, Chicago, Illinois."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven M","family":"Kymes","sequence":"additional","affiliation":[{"name":"Center for Economic Evaluation in Medicine, Washington University School of Medicine, St Louis, Missouri."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2013,11,1]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199912000-00006"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.120.6_suppl.477S"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000150026.85210.13"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000145232.46143.40"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000186369.91799.44"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181ab86ed"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199706000-00015"},{"key":"e_1_3_2_9_2","unstructured":"Merrill CH Elixhauser A; US Department of Health & Human Services; Agency for Healthcare Research and Quality. 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