Patient and Hospitalization Characteristics Associated With Increased Postacute Care Facility Discharges From US Hospitals

Abstract

Background/objectives: The number of patients discharged to postacute care (PAC) facilities after hospitalization increased by 50% nationally between 1996 and 2010. We sought to describe payors and patients most affected by this trend and to identify diagnoses for which PAC facility care may be substituting for continued hospital care.

Design: Retrospective analysis of the National Hospital Discharge Survey from 1996 to 2010.

Setting: Adult discharges from a national sample of non-Federal hospitals.

Participants/exposures: Adults admitted and discharged to a PAC facility between 1996 and 2010. Our analysis includes 2.99 million sampled discharges, representative of 386 million discharges nationally.

Measurements: Patient demographic and hospitalization characteristics, including length of stay (LOS) and diagnoses treated.

Results: More than half (50.7%) of all patients discharged to PAC facilities were 80 years old or older in 2010; 40% of hospitalizations in this age group ended with a PAC stay. Decreases in LOS and increases in PAC facility use were consistent across payors and patient demographics. PAC facilities may be substituting for continued inpatient care for patients with pneumonia, hip fracture, and sepsis as these diagnoses demonstrated the clearest trends of decreasing LOS and increasing discharges to PAC facilities.

Conclusions: The rise in discharges to PAC facilities is occurring in all age groups and payors, though the predominant population is the very old Medicare patient, for whom successful rehabilitation may be most unsure. PAC facility care may be increasingly substituted for prolonged hospitalizations for patients with pneumonia, hip fracture, and sepsis.

Figure 1. Trends in length of stay and discharges to post-acute care and home, stratified by age group

Trends in the percentage of patients discharged home or to post-acute care facilities (PAC) are shown using loess smoothing (data points are represented as filled circles, unfilled circles, and unfilled triangles, respectively as age increases with trend lines fit to these data point). Trends are calculated as a relative percent change compared to 1996 levels. Length of stay is reported as mean number of days.For 18–64 year-olds discharged to PAC, slope of line is 6.54 (95% CI 5.64– 7.45) with p-value <0.001. For 65–79 year-olds discharged to PAC, slope is 3.20 (2.58– 3.83) with p-value <0.001. For those 80 and above discharged to PAC, slope is 1.313 (0.99– 1.63) with p-value <0.001.

Figure 2. Trends in length of stay and discharges to post-acute care and home, stratified by payor source

Trends in the percentage of patients discharged home or to post-acute care facilities (PAC) are shown using loess smoothing (data points are represented as filled circles, unfilled circles, and unfilled triangles, respectively). Trends are calculated as a relative percent change compared to 1996 levels. Length of stay is reported as mean number of days. For those discharged to PAC, among Medicare patients slope is 4.69 (95% CI 3.69– 5.69; p-value <0.001), among Medicare patients slope is 2.85 (2.05–3.65; p-value <0.001), and among patients with private insurance slope is 3.617 (1.99–5.24; p-value 0.001).

Figure 3. Trends in length of stay and discharges to post-acute care by diagnosis

Trends in mean length of stay (left Y-axis, filled circles) and relative percent change in discharge to PAC compared to 1996 levels (right Y-axis, + signs) are displayed over time within each of the ten most common diagnoses associated with discharge to PAC; trend lines are fit using loess smoothing. Trends are adjusted for age and for payor type.