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A comparison of free-standing versus co-located long-term acute care hospitals

Kahn, JM and Barnato, AE and Lave, JR and Pike, F and Weissfeld, LA and Le, TQ and Angus, DC and Gold, JA (2015) A comparison of free-standing versus co-located long-term acute care hospitals. PLoS ONE, 10 (10).

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Background Long-term acute care hospitals (LTACs) provide specialized treatment for patients with chronic critical illness. Increasingly LTACs are co-located within traditional short-stay hospitals rather than operated as free-standing facilities, which may affect LTAC utilization patterns and outcomes. Methods We compared free-standing and co-located LTACs using 2005 data from the United States Centers for Medicare & Medicaid Services. We used bivariate analyses to examine patient characteristics and timing of LTAC transfer, and used propensity matching and multivariable regression to examine mortality, readmissions, and costs after transfer. Results Of 379 LTACs in our sample, 192 (50.7%) were free-standing and 187 (49.3%) were co-located in a short-stay hospital. Co-located LTACs were smaller (median bed size: 34 vs. 66, p <0.001) and more likely to be for-profit (72.2% v. 68.8%, p = 0.001) than freestanding LTACs. Co-located LTACs admitted patients later in their hospital course (average time prior to transfer: 15.5 days vs. 14.0 days) and were more likely to admit patients for ventilator weaning (15.9% vs. 12.4%). In the multivariate propensity-matched analysis, patients in co-located LTACs experienced higher 180-day mortality (adjusted relative risk: 1.05, 95% CI: 1.00-1.11, p = 0.04) but lower readmission rates (adjusted relative risk: 0.86, 95% CI: 0.75-0.98, p = 0.02). Costs were similar between the two hospital types (mean difference in costs within 180 days of transfer: -$3,580, 95% CI: -$8,720 -$1,550, p = 0.17). Conclusions Compared to patients in free-standing LTACs, patients in co-located LTACs experience slightly higher mortality but lower readmission rates, with no change in overall resource use as measured by 180 day costs.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Kahn, JMjeremykahn@pitt.eduJMK1900000-0001-9688-5576
Barnato, AE
Lave, JRlave@pitt.eduLAVE
Pike, Ffrp3@pitt.eduFRP3
Weissfeld, LA
Le, TQ
Angus, DCangusdc@pitt.eduANGUSDC0000-0002-7026-5181
Gold, JA
ContributionContributors NameEmailPitt UsernameORCID
Centers: Other Centers, Institutes, Offices, or Units > Center for Research on Health Care
Date: 6 October 2015
Date Type: Publication
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Journal or Publication Title: PLoS ONE
Volume: 10
Number: 10
DOI or Unique Handle: 10.1371/journal.pone.0139742
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Biostatistics
Graduate School of Public Health > Health Policy & Management
School of Medicine > Critical Care Medicine
Refereed: Yes
Date Deposited: 23 Aug 2016 14:42
Last Modified: 30 Mar 2021 11:55


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