Long-term Acute Care Hospital Utilization After Critical Illness

Abstract

Context Long-term acute care hospitals have emerged as a novel approach for the care of patients recovering from severe acute illness, but the extent and growth of their activity at the national level is unknown. Objective To examine temporal trends in long-term acute care hospital utilization after an episode of critical illness among fee-for-service Medicare beneficiaries ≥ 65 years of age. Design, Setting and Patients Retrospective cohort study using the Medicare Provider Analysis and Review files from 1997 to 2006. We included all Medicare hospitalizations involving admission to an intensive care unit of an acute-care, non-federal hospital within the continental United States. Main outcome measures Overall long-term acute care utilization, associated costs, and survival following transfer. Results The number of long-term acute care hospitals in the United States increased at a mean rate of 8.8% per year, from 192 in 1997 to 408 in 2006. During that time, the annual number of long-term acute care admissions after critical illness increased from 13,732 to 40,353, with annual costs increasing from $484 million to $1.325 billion. The age-standardized population incidence of long-term acute care utilization after critical illness increased from 38.1/100,000 in 1997 to 99.7/100,000 in 2006, with greater use among male individuals and black individuals in all time periods. Over time, transferred patients had higher numbers of comorbidities (5.0 in 1997–2000 versus 5.8 in 2004–2006, p<0.001), and were more likely to receive mechanical ventilation at the long-term acute care hospital (16.4% in 1997–2000 versus 29.8% in 2004–2006, p<0.001). One-year mortality after long-term acute care hospital admission was high throughout the study period: 50.7% in 1997–2000 and 52.2% in 2004–2006. Conclusions Long-term acute care hospital utilization after critical illness is common and increasing. Survival among Medicare beneficiaries transferred to long-term acute care after critical illness is poor.

Implementing a care bundle approach reduces ventilator-associated pneumonia and delays ventilator-associated tracheobronchitis in children: differences according to endotracheal or tracheostomy devices

“…This has generated debate regarding the absence of a gold standard definition 14,15 and the exclusion of PMV patients because of the policy of discharging them to long-term care facilities. 16 Furthermore, VAT is a more frequent condition in children than VAP and is an important cause of morbidity and health resource consumption, [5][6][7] which is consistent with the present results. However, VAT has only rarely been considered in these studies, as have PMV patients, who are significant consumers of healthcare resources.…”

Implementing a care bundle approach reduces ventilator-associated pneumonia and delays ventilator-associated tracheobronchitis in children: differences according to endotracheal or tracheostomy devices

“…This has generated debate regarding the absence of a gold standard definition 14,15 and the exclusion of PMV patients because of the policy of discharging them to long-term care facilities. 16 Furthermore, VAT is a more frequent condition in children than VAP and is an important cause of morbidity and health resource consumption, [5][6][7] which is consistent with the present results. However, VAT has only rarely been considered in these studies, as have PMV patients, who are significant consumers of healthcare resources.…”

Survival, Function, and Cognition After Hospitalization in Long-Term Acute Care Hospitals

“…Second, we included all patients with an LTCH hospitalization and prehospitalization HRS assessments, which circumvents issues of recall bias of prior health status and selection bias of including healthier patients who are more likely to consent to participate. Third, our observed rates of survival are consistent with prior literature, which provides external validity to our findings . Fourth, we examined functional and cognitive outcomes in addition to survival after an LTCH stay, patient-centered outcomes that matter to older adults …”

Severe Obesity and Prolonged Postoperative Mechanical Ventilation in Elderly Vascular Surgery Patients

“…Most published data indicate that PPMV is associated with increased mortality and morbidity and increased medical costs [11][12][13][14][15][16]. We found, as did previous investigators, that the death rate in elderly patients requiring PPMV was considerably higher than patients who did not require PPMV [31,45].…”

Implementing a care bundle approach reduces ventilator-associated pneumonia and delays ventilator-associated tracheobronchitis in children: differences according to endotracheal or tracheostomy devices

“…This has generated debate regarding the absence of a gold standard definition 14,15 and the exclusion of PMV patients because of the policy of discharging them to long-term care facilities. 16 Furthermore, VAT is a more frequent condition in children than VAP and is an important cause of morbidity and health resource consumption, [5][6][7] which is consistent with the present results. However, VAT has only rarely been considered in these studies, as have PMV patients, who are significant consumers of healthcare resources.…”

Survival, Function, and Cognition After Hospitalization in Long-Term Acute Care Hospitals

“…Second, we included all patients with an LTCH hospitalization and prehospitalization HRS assessments, which circumvents issues of recall bias of prior health status and selection bias of including healthier patients who are more likely to consent to participate. Third, our observed rates of survival are consistent with prior literature, which provides external validity to our findings . Fourth, we examined functional and cognitive outcomes in addition to survival after an LTCH stay, patient-centered outcomes that matter to older adults …”

Severe Obesity and Prolonged Postoperative Mechanical Ventilation in Elderly Vascular Surgery Patients

“…Most published data indicate that PPMV is associated with increased mortality and morbidity and increased medical costs [11][12][13][14][15][16]. We found, as did previous investigators, that the death rate in elderly patients requiring PPMV was considerably higher than patients who did not require PPMV [31,45].…”

Implementing a care bundle approach reduces ventilator-associated pneumonia and delays ventilator-associated tracheobronchitis in children: differences according to endotracheal or tracheostomy devices

“…This has generated debate regarding the absence of a gold standard definition 14,15 and the exclusion of PMV patients because of the policy of discharging them to long-term care facilities. 16 Furthermore, VAT is a more frequent condition in children than VAP and is an important cause of morbidity and health resource consumption, [5][6][7] which is consistent with the present results. However, VAT has only rarely been considered in these studies, as have PMV patients, who are significant consumers of healthcare resources.…”

Survival, Function, and Cognition After Hospitalization in Long-Term Acute Care Hospitals

“…Second, we included all patients with an LTCH hospitalization and prehospitalization HRS assessments, which circumvents issues of recall bias of prior health status and selection bias of including healthier patients who are more likely to consent to participate. Third, our observed rates of survival are consistent with prior literature, which provides external validity to our findings . Fourth, we examined functional and cognitive outcomes in addition to survival after an LTCH stay, patient-centered outcomes that matter to older adults …”

Severe Obesity and Prolonged Postoperative Mechanical Ventilation in Elderly Vascular Surgery Patients

“…Most published data indicate that PPMV is associated with increased mortality and morbidity and increased medical costs [11][12][13][14][15][16]. We found, as did previous investigators, that the death rate in elderly patients requiring PPMV was considerably higher than patients who did not require PPMV [31,45].…”