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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.CC

Abstract

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.

Authors+Show Affiliations

Department of Anesthesiology and Critical Care Medicine, The George Washington University Medical Center, DC 20037, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

10708164

Citation

Seneff, M G., et al. "The Impact of Long-term Acute-care Facilities On the Outcome and Cost of Care for Patients Undergoing Prolonged Mechanical Ventilation." Critical Care Medicine, vol. 28, no. 2, 2000, pp. 342-50.
Seneff MG, Wagner D, Thompson D, et al. 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;28(2):342-50.
Seneff, M. G., Wagner, D., Thompson, D., Honeycutt, C., & Silver, M. R. (2000). The impact of long-term acute-care facilities on the outcome and cost of care for patients undergoing prolonged mechanical ventilation. Critical Care Medicine, 28(2), 342-50.
Seneff MG, et al. 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;28(2):342-50. PubMed PMID: 10708164.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The impact of long-term acute-care facilities on the outcome and cost of care for patients undergoing prolonged mechanical ventilation. AU - Seneff,M G, AU - Wagner,D, AU - Thompson,D, AU - Honeycutt,C, AU - Silver,M R, PY - 2000/3/9/pubmed PY - 2000/3/18/medline PY - 2000/3/9/entrez SP - 342 EP - 50 JF - Critical care medicine JO - Crit Care Med VL - 28 IS - 2 N2 - 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. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/10708164/The_impact_of_long_term_acute_care_facilities_on_the_outcome_and_cost_of_care_for_patients_undergoing_prolonged_mechanical_ventilation_ L2 - https://dx.doi.org/10.1097/00003246-200002000-00009 DB - PRIME DP - Unbound Medicine ER -