CARING FOR THE CRITICALLY ILL PATIENT Long-term Acute Care Hospital Utilization After Critical Illness

APPROXIMATELY 10% TO 20% of patients recovering from critical illness experience persistent organ failures necessitating complex care for a prolonged period of time. Traditionally these patients spent their entire acute care episode in a general medical-surgical hospital. However, in recent years longterm acute care hospitals have emerged as a novel care model for patients recovering from severe acute illness. Long-term acute care hospitals are defined by the Centers for Medicare & Medicaid Services (CMS) as acute care hospitals with a mean length of stay equal to or greater than 25 days. Typically these hospitals provide care for patients who do not require all of the services of a short-stay hospital but still have significant ongoing care needs. In the post–intensive care unit (ICU) setting, these hospitals act as specialized hospitals for patients requiring prolonged mechanical ventilation and those with other types of chronic critical illness. With the aging of the population and advances in critical care, the incidence of chronic critical illness is expected to increase in the coming years. Long-term acute care hospitals could play a particularly important role in caring for these patients. Yet despite their increasing role, few population-based data exist on overall patterns of longterm acute care use, and little is known about how the characteristics of patients transferred into long-term acute care have evolved over time. The purpose of this study was to examine the epidemiology of long-term acute care hospital utilization following hospitalization for critical illness in the United States using fee-for-service Medicare beneficiaries. Such information can inform health policy and future planning with respect to these hospitals, as well as help policy makers understand how novel organizational structures affect health care as a whole. Author Affiliations: Division of Pulmonary, Allergy, and Critical Care (Dr Kahn), Center for Clinical Epidemiology and Biostatistics, School of Medicine (Dr Kahn and Mss Benson and Appleby), Leonard Davis Institute of Health Economics (Dr Kahn), University of Pennsylvania, Philadelphia; Division of Pulmonary and Critical Care; University of North Carolina School of Medicine, Chapel Hill (Dr Carson); Division of Pulmonary and Critical Care, University of Michigan School of Medicine, Ann Arbor (Dr Iwashyna). Corresponding Author: Jeremy M. Kahn, MD, MSc, Division of Pulmonary, Allergy, and Critical Care, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Blockley Hall 723, 423 Guardian Dr, Philadelphia, PA 19104 (jmkahn @mail.med.upenn.edu). Caring for the Critically Ill Patient Section Editor: Derek C. Angus, MD, MPH, Contributing Editor, JAMA ([email protected]). Context Long-term acute care hospitals have emerged as a novel approach for the care of patients recovering from severe acute illness, but the extent and increases in their activity at the national level are unknown.