Department of Critical Care Medicine, Clinical Research, Investigation and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh School of Medicine, PA 15261, USA.
Med Care. 2013 Jan;51(1):4-10. doi: 10.1097/MLR.0b013e31826528a7.
For patients recovering from severe acute illness, admission to a long-term acute care hospital (LTAC) is an increasingly common alternative to continued management in an intensive care unit (ICU).
To examine the effectiveness of LTAC transfer in patients with chronic critical illness.
Retrospective cohort study in United States hospitals from 2002 to 2006.
Medicare beneficiaries with chronic critical illness, defined as mechanical ventilation and at least 14 days of intensive care.
Survival, costs, and hospital readmissions. We used multivariate analyses and instrumental variables to account for differences in patient characteristics, the timing of LTAC transfer, and selection bias.
A total of 234,799 patients met our definition of chronic critical illness. Of these, 48,416 (20.6%) were transferred to an LTAC. In the instrumental variable analysis, patients transferred to an LTAC experienced similar survival compared with patients who remained in an ICU [adjusted hazard ratio=0.99; 95% confidence interval (CI), 0.96 to 1.01; P=0.27). Total hospital-related costs in the 180 days after admission were lower among patients transferred to LTACs (adjusted cost difference=-$13,422; 95% CI, -26,662 to -223, P=0.046). This difference was attributable to a reduction in skilled nursing facility admissions (adjusted admission rate difference=-0.591; 95% CI, -0.728 to -0.454; P<0.001). Total Medicare payments were higher (adjusted cost difference=$15,592; 95% CI, 6343 to 24,842; P=0.001).
Patients with chronic critical illness transferred to LTACs experience similar survival compared with patients who remain in ICUs, incur fewer health care costs driven by a reduction in postacute care utilization, however, invoke higher overall Medicare payments.
对于从严重急性疾病中康复的患者来说，入住长期急性护理医院（LTAC）是一种越来越常见的替代方案，可替代在重症监护病房（ICU）中进行持续治疗。
研究慢性危重病患者转入 LTAC 的效果。
2002 年至 2006 年在美国医院进行的回顾性队列研究。
患有慢性危重病的医疗保险受益人，定义为使用机械通气和至少 14 天的重症监护。
生存、成本和医院再入院。我们使用多元分析和工具变量来解释患者特征、LTAC 转移的时机和选择偏差的差异。
共有 234799 名患者符合我们对慢性危重病的定义。其中，48416 名（20.6%）患者转入 LTAC。在工具变量分析中，转入 LTAC 的患者与留在 ICU 的患者的生存率相似[调整后的危险比=0.99；95%置信区间（CI），0.96 至 1.01；P=0.27]。在入院后 180 天内，转入 LTAC 的患者的总医院相关费用较低（调整后的费用差异=-$13422；95%CI，-26662 至 -223；P=0.046）。这一差异归因于熟练护理机构入院率的降低（调整后的入院率差异=-0.591；95%CI，-0.728 至 -0.454；P<0.001）。总的医疗保险支出更高（调整后的费用差异=$15592；95%CI，6343 至 24842；P=0.001）。
转入 LTAC 的慢性危重病患者的生存率与留在 ICU 的患者相似，由于减少了急性后护理的使用，导致医疗成本降低，但总体医疗保险支出更高。
