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.

Predicting Discharge to a Long-Term Acute Care Hospital After Admission to an Intensive Care Unit

“…Our findings are especially relevant because of the current initiatives to improve care practices for patients who are chronically critically ill. 4,10,18,29,30 Early identification of LTACh use may allow clinical care teams to make appropriate arrangements for patients' care after discharge from the ICU, improve the transition of care, ensure bed availability, and avoid potential delays in patients' discharge. As emphasized by Zimmerman et al, 31 discharge planning started shortly after ICU admission allows for more efficient use of ICU resources.…”

“…2,4,8,9 As a result, the utilization and num ber of LTAChs have been increasing at a high rate. 10 Our primary objective in this study was to develop a predictive algorithm for early identification of ICU patients with a high probability of discharge to an LTACh. We hypothesized that sufficient accuracy could be achieved by using predictor variables that were available within the first 24 hours of ICU admission.…”

Long-term care hospitals in Turkey: a review

“…In the USA, patients who have not fully recovered after acute disease and require care are provided for by PAC units within nursing care institutions, home healthcare institutions, inpatient rehabilitation institutions and LTCHs (13,32). PAC expenses rose from US$ 29.3 billion in 2001 to US$ 58.8 billion in 2013; of which, LTCHs were a small part (US$ 5.2 billion) and the largest portion was for nursing care institutions at US$ 28.8 billion (32).…”

“…PAC expenses rose from US$ 29.3 billion in 2001 to US$ 58.8 billion in 2013; of which, LTCHs were a small part (US$ 5.2 billion) and the largest portion was for nursing care institutions at US$ 28.8 billion (32).…”

Respiratory Care Year in Review 2013: Airway Management, Noninvasive Monitoring, and Invasive Mechanical Ventilation

“…68 However, despite the increasing use of these facilities, little is known about the optimal management of patients at these centers, particularly how to wean those requiring PMV. 69 To that end, Jubran et al 54 designed an RCT enrolling 500 patients requiring PMV (Ͼ 21 days) with a tracheostomy who were referred for weaning at a single LTACH.…”