Dataset Information

The Role of Long-term Acute Care Hospitals in Treating the Critically Ill and Medically Complex: An Analysis of Nonventilator Patients.

ABSTRACT:

Background

Little evidence exists on the effects of receiving care in a long-term acute care hospital (LTCH).

Objective

To examine LTCH effects on mortality and Medicare payments overall and among high-acuity patients.

Research design

A retrospective cohort study of Medicare beneficiaries using probit and generalized linear models. An instrumental variable technique was used to adjust for selection bias.

Subjects

Medicare beneficiaries within 5 major diagnostic categories and not on prolonged mechanical ventilation.

Measures

Mortality (365 d) and Medicare payments (180 d) during an episode of care.

Results

LTCH care is associated with increases in Medicare payments ranging from $3146 to $17,589 (P<0.01) with no mortality benefit for 3 categories and payment reductions of $5419 and $5962 (P<0.01) at lower or similar mortality for 2 categories. LTCH patients with multiple organ failure experience lower mortality at similar or lower payments (3 categories) or similar mortality at lower payments (1 category) compared with patients in other settings, with mortality benefits between 5.4 and 9.7 percentage points (P<0.05) and payment reductions between $13,806 and $20,809 (P<0.01). For 1 category, we found no difference in mortality or payments between LTCH and non-LTCH patients with multiple organ failure. For patients with ?3 days in intensive care, LTCH care is associated with improved mortality and lower payments in 4 and 3 categories, respectively.

Conclusions

Receiving care in an LTCH may improve outcomes for some patients. Further research is needed to better define patients for whom care in these hospitals is beneficial.

SUBMITTER: Koenig L

PROVIDER: S-EPMC4470738 | biostudies-literature | 2015 Jul

REPOSITORIES: biostudies-literature

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Publications

The Role of Long-term Acute Care Hospitals in Treating the Critically Ill and Medically Complex: An Analysis of Nonventilator Patients.

Koenig Lane L Demiralp Berna B Saavoss Josh J Zhang Qian Q

Medical care 20150701 7

<h4>Background</h4>Little evidence exists on the effects of receiving care in a long-term acute care hospital (LTCH).<h4>Objective</h4>To examine LTCH effects on mortality and Medicare payments overall and among high-acuity patients.<h4>Research design</h4>A retrospective cohort study of Medicare beneficiaries using probit and generalized linear models. An instrumental variable technique was used to adjust for selection bias.<h4>Subjects</h4>Medicare beneficiaries within 5 major diagnostic categ ...[more]

PMID: 26067882

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Project description:BackgroundThe past years have witnessed dramatic changes in the population admitted to the intensive care unit (ICU). Older and sicker patients are now commonly treated in this setting due to the newly available sophisticated life support. However, the short- and long-term benefit of this strategy is scarcely studied.MethodsThe Critically Ill patients' mortality by age: Long-Term follow-up (CIMbA-LT) was a multicentric, nationwide, retrospective, observational study addressing short- and long-term prognosis of patients admitted to Portuguese multipurpose ICUs, during 4 years, according to their age and disease severity. Patients were followed for two years after ICU admission. The standardized hospital mortality ratio (SMR) was calculated according to the Simplified Acute Physiology Score (SAPS) II and the follow-up risk, for patients discharged alive from the hospital, according to official demographic national data for age and gender. Survival curves were plotted according to age group.ResultsWe included 37.118 patients, including 15.8% over 80 years old. The mean SAPS II score was 42.8 ± 19.4. The ICU all-cause mortality was 16.1% and 76% of all patients survive until hospital discharge. The SAPS II score overestimated hospital mortality [SMR at hospital discharge 0.7; 95% confidence interval (CI) 0.63-0.76] but accurately predicted one-year all-cause mortality [1-year SMR 1.01; (95% CI 0.98-1.08)]. Survival curves showed a peak in mortality, during the first 30 days, followed by a much slower survival decline thereafter. Older patients had higher short- and long-term mortality and their hospital SMR was also slightly higher (0.76 vs. 0.69). Patients discharged alive from the hospital had a 1-year relative mortality risk of 6.3; [95% CI 5.8-6.7]. This increased risk was higher for younger patients [21.1; (95% CI 15.1-39.6) vs. 2.4; (95% CI 2.2-2.7) for older patients].ConclusionsCritically ill patients' mortality peaked in the first 30 days after ICU admission. Older critically ill patients had higher all-cause mortality, including a higher hospital SMR. A long-term increased relative mortality risk was noted in patients discharged alive from the hospital, but this was more noticeable in younger patients.

Dataset Information

The Role of Long-term Acute Care Hospitals in Treating the Critically Ill and Medically Complex: An Analysis of Nonventilator Patients.

Background

Objective

Research design

Subjects

Measures

Results

Conclusions

Publications

The Role of Long-term Acute Care Hospitals in Treating the Critically Ill and Medically Complex: An Analysis of Nonventilator Patients.

Similar Datasets

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