Work

Time Toxicity: Quantifying Healthcare Utilization Attributable to Pediatric Home Ventilation

Year: 2025

Type: article

Abstract: OBJECTIVE: Determine the "time toxicity," or time burden patients experience when pursuing health-related interventions, of pediatric invasive home ventilation. STUDY DESIGN: Retrospective chart review. METHODS: We identified all patients from a single neonatal intensive care unit who received a tracheostomy with/without home ventilation (T + /-HV) from 2016 to 2024. After matching the gestational week distribution of this cohort, five controls were randomly selected for each T + /-HV patient. Healthcare encounters in the electronic medical record were compared for the cohort versus controls. All encounters on a single calendar day were counted as 1 day of healthcare utilization. RESULTS: We identified 62 patients with T + /-HV and 310 controls. Mortality was 35.5% among the T + /-HV cohort and 9% among controls. Median inpatient hospitalizations (7.0 vs. 2.0), total healthcare encounters (64.0 vs. 15.5), days of healthcare utilization (296 vs. 46), and healthcare utilization ratio (0.4 vs. 0.1) were all significantly higher for the T + /-HV cohort compared with controls. Differences were greatest in the first year of life. Among survivors in the T + /-HV cohort, decannulated patients had significantly greater healthcare utilization than those not decannulated. CONCLUSIONS: This proof-of-concept analysis quantified "time toxicity" for pediatric invasive home ventilation and demonstrated that neonates who receive a tracheostomy during their initial admission spent over half of all days in their first 2 years of life interacting with the healthcare system. "Time toxicity" could add objective information to better prepare families for what life looks like with a child using a ventilator at home.

Source: Pediatric Pulmonology

DOI: 10.1002/ppul.71081

Authors: Emily D. Johnson, Renee D. Boss, Woo Yeon Park, Khyzer B. Aziz

Institutions: Johns Hopkins University, Johns Hopkins Hospital, Johns Hopkins Medicine, Johns Hopkins Berman Institute of Bioethics

Language: English

Topic: Tracheal and airway disorders

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: bronze

Funder: U.S. National Library of Medicine