The Role of Long-term Acute Care Hospitals in Treating the Critically Ill and Medically Complex: An Analysis of Nonventilator XXXX .

@entity1 @entity697 @entity881
BACKGROUND: Little evidence exists on the effects of receiving care in a @entity697 ( @entity697 ). OBJECTIVE: To examine @entity697 effects on mortality and Medicare payments overall and among high-acuity @entity1 . RESEARCH DESIGN: A retrospective cohort study of Medicare beneficiaries using probit and generalized linear models. An instrumental variable technique was used to adjust for selection bias. SUBJECTS: Medicare beneficiaries within 5 major diagnostic categories and not on prolonged mechanical ventilation. MEASURES: Mortality (365 d) and Medicare payments (180 d) during an episode of care. RESULTS: @entity697 care is associated with increases in Medicare payments ranging from  3146 to  17,589 (P<0.01) with no mortality benefit for 3 categories and payment reductions of  5419 and  5962 (P<0.01) at lower or similar mortality for 2 categories. @entity697 @entity1 with @entity881 experience lower mortality at similar or lower payments (3 categories) or similar mortality at lower payments (1 category) compared with @entity1 in other settings, with mortality benefits between 5.4 and 9.7 percentage points (P<0.05) and payment reductions between  13,806 and  20,809 (P<0.01). For 1 category, we found no difference in mortality or payments between @entity697 and non- @entity697 @entity1 with @entity881 . For @entity1 with >= 3 days in intensive care, @entity697 care is associated with improved mortality and lower payments in 4 and 3 categories, respectively. CONCLUSIONS: Receiving care in an @entity697 may improve outcomes for some @entity1 . Further research is needed to better define @entity1 for whom care in these hospitals is beneficial.
