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. 2015;2(3):1031.
Epub 2015 Oct 11.

Trends in Long-Term Acute Care Hospital Use in Texas from 2002-2011

Anil N Makam  1 , Oanh K Nguyen  2 , Jie Zhou  3 , Kenneth J Ottenbacher, Ethan A Halm
Affiliations

Trends in Long-Term Acute Care Hospital Use in Texas from 2002-2011

Anil N Makam et al. Ann Gerontol Geriatr Res. 2015.

Abstract

Objective: To assess regional trends in long-term acute care hospital (LTAC) use over time.

Design setting participants: Retrospective study using 100% Texas Medicare data. Separate cohorts were created for each year from 2002-2011, which included all beneficiaries residing in 23 hospital referral regions (HRRs) with continuous enrollment in Parts A and B in the previous and current year, or until death.

Measurements: LTAC utilization rate was defined as the number of individuals with a LTAC stay per 100,000 Medicare beneficiaries residing in the HRR. Baseline LTAC use at the HRR-level was categorized by tertiles of use in 2002.

Results: Overall, LTAC use increased 35% from 2002-2011 and coincided with major Medicare policy changes. However, there were marked regional differences in LTAC utilization trends. From 2002-2011, HRRs in the lowest tertile of baseline LTAC use, which included regions with 0 to 1 LTAC facilities in 2002, had an increase in utilization by 211%, from 190 to 591 individuals per 100,000 persons. In contrast, HRRs in the highest tertile of baseline LTAC use, which included some of the most densely LTAC-bedded regions in the country, experienced a 21% decline (915 to 719 individuals per 100,000 persons; p<0.001 for interaction of LTAC utilization and tertile of baseline use).

Conclusion: These findings suggest substantial regional variation in the trends in LTAC use over time. Further research is needed to estimate how much of this variation is due to differences in clinical need due to increasing number of severely ill older adults versus regional market supply.

Keywords: Medicare; health services research; hospitals; long-term care; utilization.

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Conflict of interest statement

CONFLICTS OF INTEREST: The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Long-term acute care hospitalization use in Texas from 2002 to 2011 Abbreviations: TEFRA, Tax Equity and Fiscal Responsibility Act; PPS, prospective payment system; LTAC, long-term acute care hospital
Figure 2
Figure 2
Regional trends in LTAC use from 2002 to 2011 stratified by baseline LTAC utilization* *23 HRRs in Texas were included in this analysis. All HRRs in the lowest tertile of baseline LTAC use had 0 to 1 LTAC facilities in 2002. HRRs in the highest tertile of baseline LTAC use included regions having among the highest LTAC bed supply in the United States (e.g. Dallas, Fort Worth, and Houston).
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