Variation in long-term acute care hospital use after intensive care

Abstract

Long-term acute care hospitals (LTACs) are an increasingly common discharge destination for patients recovering from intensive care. In this article the authors use U.S. Medicare claims data to examine regional- and hospital-level variation in LTAC utilization after intensive care to determine factors associated with their use. Using hierarchical regression models to control for patient characteristics, this study found wide variation in LTAC utilization across hospitals, even controlling for LTAC access within a region. Several hospital characteristics were independently associated with increasing LTAC utilization, including increasing hospital size, for-profit ownership, academic teaching status, and colocation of the LTAC within an acute care hospital. These findings highlight the need for research into LTAC admission criteria and the incentives driving variation in LTAC utilization across hospitals.

Figure 1

Regional variation in long-term acute care hospital (LTAC) penetration by Dartmouth Atlas hospital referral region

Figure 2

Hospital-level variation in LTAC utilization after critical illness, by population-adjusted LTAC penetration Note: LTAC = long-term acute care hospital; HRR = hospital referral region.