Effectiveness of long-term acute care hospitalization in elderly patients with chronic critical illness

Med Care. 2013 Jan;51(1):4-10. doi: 10.1097/MLR.0b013e31826528a7.


Background: 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).

Objective: To examine the effectiveness of LTAC transfer in patients with chronic critical illness.

Research design: Retrospective cohort study in United States hospitals from 2002 to 2006.

Subjects: Medicare beneficiaries with chronic critical illness, defined as mechanical ventilation and at least 14 days of intensive care.

Measures: 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.

Results: 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).

Conclusions: 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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Chronic Disease / economics*
  • Chronic Disease / mortality
  • Critical Illness / economics*
  • Critical Illness / mortality
  • Female
  • Health Care Costs / statistics & numerical data
  • Hospital Bed Capacity
  • Hospital Charges / statistics & numerical data
  • Hospitals / statistics & numerical data*
  • Humans
  • Long-Term Care / economics*
  • Male
  • Medicare / statistics & numerical data
  • Patient Readmission / economics
  • Patient Transfer
  • Respiration, Artificial / economics
  • Retrospective Studies
  • Socioeconomic Factors
  • Survival Analysis
  • United States / epidemiology