Hospital for Special Care, University of Connecticut School of Medicine, New Britain CT, USA.
J Med Econ. 2011;14(2):141-6. doi: 10.3111/13696998.2010.551163. Epub 2011 Jan 18.
Compare clinical outcomes and costs in a study group of long-term acute care hospital (LTCH) patients with a control group of LTCH-eligible patients in an acute care hospital. LTCHs were created to provide post-acute care services not available at other post-acute settings. This is based on the premise that these patients would otherwise have stayed at acute care hospitals as high-cost outliers. The LTCH hospital is intended to deliver care to patients more efficiently, however, there are little documented clinical and financial data regarding the comparative clinical outcomes and costs for patients.
Retrospective medical and billing record review of patients from the following groups: (1) LTCH study comprising patients admitted directly from an acute care hospital to the study LTCH and discharged from the LTCH from September 2004 through August 2006; (2) a control group of LTCH-eligible, medically complex patients treated and discharged from an acute care hospital in FY 2002. The control group was selected from approximately 500 patients who had at least one of the ten most common principle diagnosis DRGs of the study LTCH with >30-day length of stay at the referring hospital and met NALTH admitting guidelines.
Discharge disposition is an important outcome measure of the quality of care of medically complex patients. The in-hospital mortality rate trended lower and home discharge was 3 times higher for the LTCH study group than for the control group. As a possible result, SNF discharge of LTCH patients was approximately half that of the control group. Both mean patient cost per day and mean total cost per patient were significantly higher in the control group than in the LTCH study group.
The patients in the LTCH study group had both better clinical outcomes and lower cost of care than the control group.
比较长期急性护理医院 (LTCH) 患者研究组与急性护理医院 LTCH 合格患者对照组的临床结果和成本。LTCH 的创建是为了提供其他康复环境无法提供的康复后护理服务。这是基于这样的前提，即这些患者否则将作为高成本的例外留在急性护理医院。LTCH 医院旨在更有效地为患者提供护理，然而，关于患者的比较临床结果和成本，几乎没有记录在案的临床和财务数据。
回顾性医疗和计费记录审查以下患者群体：（1）LTCH 研究组，包括 2004 年 9 月至 2006 年 8 月直接从急性护理医院转入研究 LTCH 并从 LTCH 出院的患者；（2）2002 年在急性护理医院接受治疗并出院的符合 LTCH 条件的医疗复杂患者对照组。对照组是从大约 500 名患者中选择的，这些患者至少有一种研究 LTCH 的十种最常见主要诊断 DRG，在转诊医院的住院时间超过 30 天，并符合 NALTH 入院标准。
出院处置是衡量医疗复杂患者护理质量的重要结果指标。LTCH 研究组的院内死亡率趋势较低，家庭出院率是对照组的 3 倍。LTCH 患者的 SNF 出院率约为对照组的一半。对照组的每位患者每天的平均患者成本和每位患者的平均总费用均明显高于 LTCH 研究组。
LTCH 研究组的患者在临床结果和护理成本方面均优于对照组。
