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Background

Long-term acute care hospitals LTACs provide specialized treatment for patients with chronic critical illness. Increasingly LTACs are co-located within traditional short-stay hospitals rather than operated as free-standing facilities, which may affect LTAC utilization patterns and outcomes.

Methods

We compared free-standing and co-located LTACs using 2005 data from the United States Centers for Medicare and Medicaid Services. We used bivariate analyses to examine patient characteristics and timing of LTAC transfer, and used propensity matching and multivariable regression to examine mortality, readmissions, and costs after transfer.

Results

Of 379 LTACs in our sample, 192 50.7% were free-standing and 187 49.3% were co-located in a short-stay hospital. Co-located LTACs were smaller median bed size: 34 vs. 66, p <0.001 and more likely to be for-profit 72.2% v. 68.8%, p = 0.001 than freestanding LTACs. Co-located LTACs admitted patients later in their hospital course average time prior to transfer: 15.5 days vs. 14.0 days and were more likely to admit patients for ventilator weaning 15.9% vs. 12.4%. In the multivariate propensity-matched analysis, patients in co-located LTACs experienced higher 180-day mortality adjusted relative risk: 1.05, 95% CI: 1.00–1.11, p = 0.04 but lower readmission rates adjusted relative risk: 0.86, 95% CI: 0.75–0.98, p = 0.02. Costs were similar between the two hospital types mean difference in costs within 180 days of transfer: -$3,580, 95% CI: -$8,720 –$1,550, p = 0.17.

Conclusions

Compared to patients in free-standing LTACs, patients in co-located LTACs experience slightly higher mortality but lower readmission rates, with no change in overall resource use as measured by 180 day costs.



Autor: Jeremy M. Kahn , Amber E. Barnato, Judith R. Lave, Francis Pike, Lisa A. Weissfeld, Tri Q. Le, Derek C. Angus

Fuente: http://plos.srce.hr/



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