Makam Anil N, Nguyen Oanh K, Zhou Jie, Ottenbacher Kenneth J, Halm Ethan A
Division of General Internal Medicine, UT Southwestern Medical Center, Dallas, TX.
Sealy Center on Aging, University of Texas Medical Branch, Galveston TX.
Ann Gerontol Geriatr Res. 2015;2(3). Epub 2015 Oct 11.
To assess regional trends in long-term acute care hospital (LTAC) use over time.
Retrospective study using 100% Texas Medicare data. Separate cohorts were created for each year from 2002-2011, which included all beneficiaries residing in 23 hospital referral regions (HRRs) with continuous enrollment in Parts A and B in the previous and current year, or until death.
LTAC utilization rate was defined as the number of individuals with a LTAC stay per 100,000 Medicare beneficiaries residing in the HRR. Baseline LTAC use at the HRR-level was categorized by tertiles of use in 2002.
Overall, LTAC use increased 35% from 2002-2011 and coincided with major Medicare policy changes. However, there were marked regional differences in LTAC utilization trends. From 2002-2011, HRRs in the lowest tertile of baseline LTAC use, which included regions with 0 to 1 LTAC facilities in 2002, had an increase in utilization by 211%, from 190 to 591 individuals per 100,000 persons. In contrast, HRRs in the highest tertile of baseline LTAC use, which included some of the most densely LTAC-bedded regions in the country, experienced a 21% decline (915 to 719 individuals per 100,000 persons; p<0.001 for interaction of LTAC utilization and tertile of baseline use).
These findings suggest substantial regional variation in the trends in LTAC use over time. Further research is needed to estimate how much of this variation is due to differences in clinical need due to increasing number of severely ill older adults versus regional market supply.
评估长期急性病医院（LTAC）使用情况随时间的区域趋势。
设计、设置、参与者：使用100%的德克萨斯医疗保险数据进行回顾性研究。从2002年至2011年每年创建单独的队列，其中包括居住在23个医院转诊区域（HRR）的所有受益人，这些受益人在前一年和当年持续参保A部分和B部分，或直至死亡。
LTAC利用率定义为每10万名居住在HRR的医疗保险受益人中接受LTAC治疗的人数。HRR层面的基线LTAC使用情况按2002年使用情况的三分位数进行分类。
总体而言，2002年至2011年LTAC的使用增加了35%，这与医疗保险的重大政策变化相吻合。然而，LTAC使用趋势存在明显的区域差异。从2002年至2011年，基线LTAC使用处于最低三分位数的HRR（包括2002年有0至1个LTAC设施的区域）利用率增加了211%，从每10万人中的190人增加到591人。相比之下，基线LTAC使用处于最高三分位数的HRR（包括该国一些LTAC床位最密集的区域）下降了21%（从每10万人中的915人降至719人；LTAC利用率与基线使用三分位数的交互作用p<0.001）。
这些发现表明LTAC使用趋势随时间存在显著的区域差异。需要进一步研究来估计这种差异中有多少是由于重症老年患者数量增加导致的临床需求差异，以及多少是由于区域市场供应差异。
