Economic forces drive collaboration push.

Over 60 percent of CEOs surveyed say their hospital will belong to a regional, integrated health system by 1995. The question, they say, is not whether integration will happen, but how.

Characteristics and health service utilization patterns of ventilator-dependent patients cared for within a vertically integrated health system.

OBJECTIVE: To describe the characteristics and service utilization patterns of long-term ventilator-dependent patients. DESIGN: Using medical records, a cohort of ventilator-dependent patients was identified and followed. SETTING: A vertically integrated healthcare system in southwestern Pennsylvania. PATIENTS: Forty-nine adults requiring prolonged ventilatory assistance. MEASURES: Demographics, admission date, admission diagnosis, discharge diagnosis, reason for ventilator dependency, level of care to which the patient was admitted, dates of all transfer orders, dates of all transfers between levels of care, discharge destination and subsequent readmissions. RESULTS: The major reason for long-term ventilator dependency was progressive debilitating disease of either a pulmonary or nonpulmonary nature. The mean length of stay within the system was 72.6 days +/- 42.55 (median = 59 days, range = 24 to 267 days). Patients had an average of 3.3 transfers +/- 2.53 within the system (median = 3, range = 0 to 10). No delays in transfer to lower levels of care were found. Health utilization variables were largely unrelated to reason for ventilator dependency. Almost half of the patients (n = 24 or 49.0%) died in the system. Patients who died in the system were significantly older than patients for whom discharge home was possible. CONCLUSIONS: Additional studies are necessary to describe the prevalence, etiology, health status and functional status of ventilator patients at all levels of care; the impact of different system approaches on patient well-being and cost of care; and the process of medical decision making. Economic analyses of costs and outcomes for ventilator-dependent patients using a cost-utility approach are also needed.

Provider Magazine surveys top 40 nursing facility chains.

Provider magazine's annual survey of the Top 40 nursing facility chains in the United States has found that while occupancy rates have gone up from an average of 89.4 percent in 1990 to 90.3 percent last year, total reported revenues have decreased. In 1990, reported revenues totaled $7.4 billion. Last year that figure fell to $6.9 billion. Part of the reason for the change may be the drop in the percentage of private pay residents, which fell an average of 3 percent over the last year. There was one new player in the Top 10 in 1991--VHA Long Term Care, which moved up from number 26 in 1990. Growth was reported among other Top 20 chains also, which garnered an increase in beds of nearly 12,000, to 345,142. The Forum Group jumped from number 35 in 1990 to 16 last year with an increase of more than 3,000 beds. Also of significance was a 50 percent increase in the number of companies going public, bringing the total of publicly held nursing facility corporations to 15. The new public players are Mediplex, Integrated Health Services, Inc., GranCare, Genesis Health Ventures, and Health and Retirement Corporation (HCR).