The impact of long-term acute-care facilities on the outcome and cost of care for patients undergoing prolonged mechanical ventilation

Crit Care Med. 2000 Feb;28(2):342-50. doi: 10.1097/00003246-200002000-00009.


Objectives: To compare the 6-month mortality rate of chronically ventilated patients treated either exclusively in a traditional acute-care hospital or transferred during hospitalization to a long-term acute-care facility. To analyze the hospital cost of care and estimate the amount of uncompensated care incurred by acute-care hospitals under the Medicare prospective payment diagnostic related groups system.

Design: Retrospective chart review and questionnaire.

Setting: Fifty-four acute-care referral hospitals and 26 longterm acute-care institutions.

Patients: A total of 432 ventilated patients selected from 3,266 patients referred but not transferred to a study long-term acute-care facility and 1,702 ventilated patients from 4,174 patients referred and then subsequently transferred to the long-term acute-care facility. Six-month outcomes were determined for the subgroup of patients > or =65 yrs old (279 and 1,340 patients, respectively). Hospital charges were available for 192 of the 279 nontransferred patients who were > or =65 yrs old and 1,332 of the 1,340 transferred patients.

Interventions: None.

Measurements and main results: The 6-month mortality rate was 67.4% for the 279 nontransferred patients and 67.2% for the 1,340 transferred patients. On multiple regression analysis, variables associated with the 6-month mortality rate included initial admitting diagnosis, age, the acute physiology score, and presence of decubitus ulcer. After controlling for these variables, there was no significant difference in 6-month mortality rate, but admission to the long-term acute-care facility was associated with a longer mean survival time. Average total hospital costs for the 192 nontransferred patients was $78,474, and estimated Medicare reimbursement was $62,472, resulting in an average of $16,002 of uncompensated care per patient. Estimated costs for the long-term acute-care facility admissions were $56,825.

Conclusions: Patients undergoing prolonged ventilation have high hospital and 6-month mortality rates, and 6-month outcomes are not significantly different for those transferred to long-term acute-care facilities. These patients generate high costs, and acute-care hospitals are significantly underreimbursed by Medicare for these costs. Acute-care hospitals can reduce the amount of uncompensated care by earlier transfer of appropriate patients to a long-term acute-care facility.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Cost Control
  • Diagnosis-Related Groups / economics
  • Female
  • Health Services Research
  • Hospital Costs / statistics & numerical data*
  • Hospital Mortality*
  • Humans
  • Logistic Models
  • Long-Term Care / economics*
  • Male
  • Medicare / economics
  • Outcome Assessment, Health Care
  • Patient Transfer / statistics & numerical data
  • Referral and Consultation / economics
  • Regression Analysis
  • Respiration, Artificial / economics*
  • Respiration, Artificial / mortality*
  • Retrospective Studies
  • Skilled Nursing Facilities / economics*
  • Surveys and Questionnaires
  • Survival Analysis
  • Time Factors
  • Uncompensated Care / economics*
  • United States