Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas.
Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas.
J Am Geriatr Soc. 2019 Nov;67(11):2282-2288. doi: 10.1111/jgs.16106. Epub 2019 Aug 26.
Long-term acute care (LTAC) hospitals provide extended complex post-acute care to more than 120 000 Medicare beneficiaries annually, with the goal of helping patients to regain independence and recover. Because little is known about patients' long-term outcomes, we sought to examine the clinical course after LTAC admission.
Nationally representative 5-year cohort study using 5% Medicare data from 2009 to 2013.
LTAC hospitals.
Hospitalized Medicare fee-for-service beneficiaries 65 years of age or older who were transferred to an LTAC hospital.
Mortality, recovery (defined as achieving 60 consecutive days alive without inpatient care), time spent in an inpatient facility following LTAC hospital admission, receipt of an artificial life-prolonging procedure (feeding tube, tracheostomy, hemodialysis), and palliative care physician consultation.
Of 14 072 hospitalized older adults transferred to an LTAC hospital, median survival was 8.3 months, and 1- and 5-year survival rates were 45% and 18%, respectively. Following LTAC admission, 53% never achieved a 60-day recovery. The median time of their remaining life a patient spent as an inpatient after LTAC admission was 65.6% (interquartile range = 21.4%-100%). More than one-third (36.9%) died in an inpatient setting, never returning home after the LTAC admission. During the preceding hospitalization and index LTAC admission, 30.9% received an artificial life-prolonging procedure, and 1% had a palliative care physician consultation.
Hospitalized older adults transferred to LTAC hospitals have poor survival, spend most of their remaining life as an inpatient, and frequently undergo life-prolonging procedures. This prognostic understanding is essential to inform goals of care discussions and prioritize healthcare needs for hospitalized older adults admitted to LTAC hospitals. Given the exceedingly low rates of palliative care consultations, future research is needed to examine unmet palliative care needs in this population. J Am Geriatr Soc 67:2282-2288, 2019.
长期急性护理（LTAC）医院每年为超过 120000 名医疗保险受益人提供长期复杂的康复护理，以帮助患者恢复独立和康复。由于对患者的长期预后知之甚少，我们试图研究 LTAC 入院后的临床过程。
使用 2009 年至 2013 年的 Medicare 数据的全国代表性 5 年队列研究。
LTAC 医院。
年龄在 65 岁或以上、转入 LTAC 医院的医疗保险收费服务受益人。
死亡率、康复（定义为连续 60 天无住院治疗）、LTAC 医院入院后在住院设施中花费的时间、接受人工延长生命的程序（喂养管、气管切开术、血液透析）和姑息治疗医生咨询。
在 14072 名转入 LTAC 医院的住院老年患者中，中位生存时间为 8.3 个月，1 年和 5 年生存率分别为 45%和 18%。LTAC 入院后，53%的患者从未实现 60 天的康复。LTAC 入院后，患者作为住院患者度过的剩余生命时间中位数为 65.6%（四分位距=21.4%-100%）。超过三分之一（36.9%）的患者在住院期间死亡，从未在 LTAC 入院后返回家中。在前一次住院和指数 LTAC 入院期间，30.9%的患者接受了人工延长生命的程序，1%的患者接受了姑息治疗医生的咨询。
转入 LTAC 医院的住院老年患者生存状况较差，大部分时间都作为住院患者度过，并且经常接受延长生命的程序。这种预后理解对于告知医疗保健需求和为转入 LTAC 医院的住院老年患者确定医疗保健需求的优先级至关重要。鉴于姑息治疗咨询的比例极低，未来需要研究该人群中未满足的姑息治疗需求。美国老年医学会 67:2282-2288,2019。
