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首页> 外文期刊>Medical care >The Role of Long-term Acute Care Hospitals in Treating the Critically Ill and Medically Complex An Analysis of Nonventilator Patients
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The Role of Long-term Acute Care Hospitals in Treating the Critically Ill and Medically Complex An Analysis of Nonventilator Patients

机译：长期急性护理医院在治疗重症和医疗综合体中的作用非呼吸机患者的分析

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Background:Little evidence exists on the effects of receiving care in a long-term acute care hospital (LTCH).Objective:To examine LTCH effects on mortality and Medicare payments overall and among high-acuity patients.Research Design:A retrospective cohort study of Medicare beneficiaries using probit and generalized linear models. An instrumental variable technique was used to adjust for selection bias.Subjects:Medicare beneficiaries within 5 major diagnostic categories and not on prolonged mechanical ventilation.Measures:Mortality (365 d) and Medicare payments (180 d) during an episode of care.Results:LTCH care is associated with increases in Medicare payments ranging from $3146 to $17,589 (P<0.01) with no mortality benefit for 3 categories and payment reductions of $5419 and $5962 (P<0.01) at lower or similar mortality for 2 categories. LTCH patients with multiple organ failure experience lower mortality at similar or lower payments (3 categories) or similar mortality at lower payments (1 category) compared with patients in other settings, with mortality benefits between 5.4 and 9.7 percentage points (P<0.05) and payment reductions between $13,806 and $20,809 (P<0.01). For 1 category, we found no difference in mortality or payments between LTCH and non-LTCH patients with multiple organ failure. For patients with 3 days in intensive care, LTCH care is associated with improved mortality and lower payments in 4 and 3 categories, respectively.Conclusions:Receiving care in an LTCH may improve outcomes for some patients. Further research is needed to better define patients for whom care in these hospitals is beneficial.
机译：背景：在长期急性护理医院（LTCH）中接受护理的效果的证据很少。目的：研究LTCH对整体和高敏患者死亡率和Medicare付款的影响。研究设计：一项回顾性队列研究使用概率和广义线性模型的Medicare受益人。研究人员使用了一种工具可变技术来调整选择偏倚。受试者：5种主要诊断类别中的Medicare受益人，而不是长时间的机械通气措施：一次护理期间的死亡率（365 d）和Medicare付款（180 d）。 LTCH护理与Medicare支付的增加（从$ 3146到$ 17,589）相关（P <0.01），对于3种类别没有死亡率，而对于较低或类似死亡率的2种类别，支付减少了5419美元和$ 5962（P <0.01）。与其他情况下的患者相比，患有多器官功能衰竭的LTCH患者在相似或更低剂量下（3类）或更低剂量（1类）下的死亡率较低，其死亡率获益在5.4至9.7个百分点之间（P <0.05），付款减少额在$ 13,806到$ 20,809之间（P <0.01）。对于1类，我们发现LTCH与多器官功能衰竭的非LTCH患者之间的死亡率或付款无差异。对于重症监护期为3天的患者，LTCH护理分别可提高死亡率和降低4类和3类支付。结论：在LTCH中接受护理可能会改善某些患者的预后。需要进一步研究以更好地定义在这些医院中对其有益的患者。

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