A Comparison of Free-Standing versus Co-Located Long-Term Acute Care Hospitals

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. We com...

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Bibliographic Details
Published in:PloS one Vol. 10; no. 10; p. e0139742
Main Authors: Kahn, Jeremy M., Barnato, Amber E., Lave, Judith R., Pike, Francis, Weissfeld, Lisa A., Le, Tri Q., Angus, Derek C.
Format: Journal Article
Language:English
Published: United States Public Library of Science 06.10.2015
Public Library of Science (PLoS)
Subjects:
Bivariate analysis
Care and treatment
Collaboration
Costs
Critical care
Critically ill persons
Demographic aspects
Government programs
Health care
Health Care Costs
Health care expenditures
Health care policy
Hospital Mortality
Hospitalization - economics
Hospitalization - statistics & numerical data
Hospitals
Hospitals, Private
Humans
Illnesses
Intensive care
Length of Stay - economics
Length of Stay - statistics & numerical data
Long term care facilities
Medicaid
Medical care utilization
Medicare
Medicine
Mortality
Patient Readmission - economics
Patient Readmission - statistics & numerical data
Patient Transfer - economics
Patient Transfer - statistics & numerical data
Patients
Public health
Regression analysis
Services
United States
Ventilators
Weaning
United States
Washington DC
Pittsburgh Pennsylvania
United States > US
Pennsylvania
ISSN:1932-6203, 1932-6203
Online Access:Get full text
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Summary: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. We compared free-standing and co-located LTACs using 2005 data from the United States Centers for Medicare & 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. 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). 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.
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Competing Interests: Dr. Kahn has received speaking honoraria an travel from the National Association of Long-term Hospitals, an advocacy organization representing non-profit LTACHs. Drs. Angus and Kahn are employed, in part, by the University of Pittsburgh Medical Center, which hosts a co-located LTACH within one of its acute care hospitals. Statistics Collaborative, Inc. provided support in the form of salary for author LAW. This affiliation does alter the authors' adherence to PLOS ONE polices on sharing data and materials. The other authors declare that they have no competing interests.
Conceived and designed the experiments: JMK AEB JRL FP LAW TQL DCA. Performed the experiments: JMK FP TQL. Analyzed the data: JMK FP TQL. Contributed reagents/materials/analysis tools: JMK. Wrote the paper: JMK AEB JRL FP LAW TQL DCA.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0139742