JAMA logoThe number of long term acute care hospitals has doubled from 1997-2006 and it was observed that the number of patients who were moved to long term acute care hospital after a serious illness had tripled. Jeremy M. Kahn, M.D., M.Sc., of the University of Pennsylvania, Philadelphia, and colleagues evaluated long-term acute care hospital utilization following hospitalization in an ICU for critical illness. This was particularly observed among fee-for-service Medicare beneficiaries who were aged 65 years or older. Expert’s analyzed data from the Medicare Provider Analysis and Review files from 1997 to 2006.It was also identified that 1 year survival for these patients was not satisfactory.

Centers for Medicare & Medicaid Services informed that the average number of days that a patient may spend in a long term acute care hospital was 25 days or greater. The hospital would provide care for those patients specifically who do not require all services of a short stay but the patients must have important care needs. The authors say the ICU units of these hospitals perform the same as specialized hospitals. Specifically for patients who require prolonged mechanical ventilation and those with other types of chronic critical illness. They further reveal that the need and utilization of these hospitals may augment due to an increase in the aging population.

“Approximately 10 percent to 20 percent of patients recovering from critical illness experience persistent organ failures necessitating complex care for a prolonged period of lime. Traditionally these patients spent their entire acute care episode in a general medical-surgical hospital. However, in recent years long-term acute care hospitals have emerged as a novel care model for patients recovering from severe acute illness,” according to background information in the article.

Experts found a steady increase in long-term acute care transfers, as well as a proportion of all ICU discharges. The critical care hospitals increased transfers to acute care hospitals from 13,732 in 1997 to 40,353 in 2006. The number of acute care hospital increased from 192 in 1997 to 408 in 2006. The average rate of increase was 8.8 percent per year. It was also observed that the transfers after critical illness increased from 38.1 per 100,000 capita in 1997 to 99.7 per 100,000 capita in 2006. Transfers of male and black individuals in all periods were observed to be higher. The total cost increased from $484 million in 1997 to $1.325 billion in 2006.

“Over time, transferred patients had higher numbers of [co-existing illnesses] (5.0 in 1997-¬2000 vs. 5.8 in 2004-2006) and were more likely to receive mechanical ventilation at the long-term acute care hospital (16.4 percent in 1997-2000 vs. 29.8 percent in 2004-2006). One-year mortality after long-term acute care hospital admission was high throughout the study period: 50.7 percent in 1997-2000 and 52.2 percent in 2004-2006,” the authors write.

Scientists observed that the clinical and economic burden of patients with chronic critical illness is important and it is likely to expand with the ageing population and an increase in critical care that increases patient survival. The outcome of critically ill patients is not substantial and new methods are required for their care. Scientists specify that long term care hospitals are important mainly for chronically critically ill patients. The data available about this growing cost centre is minimal and does not guide or help in decision making.

This study highlights the ability of the medical system to follow new organizational innovations and it highlights the need for a diverse program of comparative effectiveness. This was mainly done in order to determine the optimal organization of care mainly for patients recovering from critical illness. It also included adopting the best approach to increase the survival and control the costs for this high-risk patient group.

This study features in the June 9 issue of JAMA.