美國LTAC 變多了，一年增加8.8%，但一年死亡率50%

死亡率50%,特別是Ventilator dependence的病人
他們認為不好
台灣健保局求之不得呢

Use of Long-Term Acute-Care Hospitals on the Rise in the U.S.


A 10-year review of Medicare beneficiary data reveals that the number of long-term acute-care hospitals increased by 8.8% annually.


In the U.S., long-term acute-care hospitals have emerged as a care model for patients who are recovering from critical illnesses. However, we know little about patterns of use for such institutions at the national level.
Researchers performed a retrospective cohort study using data from 1997 to 2006 for fee-for-service Medicare beneficiaries. Despite a 14% decline in the overall number of intensive care unit admissions during the study period, the annual number of critical care hospitalizations that ended in transfer to long-term acute-care hospitals increased from fewer than 14,000 (0.7%) to more than 40,000 (2.5%). The number of long-term acute-care hospitals increased at a mean rate of 8.8% annually, from 192 in 1997 to 408 in 2006. One-year mortality among patients who were transferred to such facilities was high, approximately 50% during the study period.
Comment: This study outlines the dramatic rise in the use of long-term acute-care hospitals in the U.S. Financial incentives, rather than proven efficacy, appear to be driving this rapid growth. Short-stay hospitals also might stand to benefit financially by discharging critically ill patients earlier. The overall 1-year survival rate for such patients, however, remains extremely low, particularly among patients who require prolonged mechanical ventilation. As the authors note, in 2008, the Centers for Medicare and Medicaid Services placed a 3-year moratorium on the construction of new long-term acute-care facilities. In an era of limited resources, more work is required to determine the most cost-effective care model to optimize outcomes for patients recovering from critical illnesses.
— Neil H. Winawer, MD, SHFM
Published in Journal Watch Hospital Medicine July 2, 2010
Citation(s):
Kahn JM et al. Long-term acute care hospital utilization after critical illness. JAMA 2010 Jun 9; 303:2253.
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