A Comparison of Outcomes between a High-Volume and Other Long-Term Care Hospitals in the Chicago Market: An Examination of Patients on Prolonged Mechanical Ventilation

Long-term care hospitals (LTCHs) are an important post-acute care setting for patients who receive prolonged mechanical ventilation (PMV).  RML Specialty Hospital (RML), with campuses in Chicago and Hinsdale, IL, is an LTCH that cares for a disproportionate share of PMV patients in Chicago area.  In this study, we compare mortality, readmissions and Medicare payments for PMV patients treated in RML versus other LTCHs in the Chicago area.  The study population consisted of Medicare beneficiaries who experienced a STACH stay with PMV (MS-DRG: 3, 4) between March 2011 and June 2013 in the Chicago area and discharged to an LTCH.  Patients who discharged to RML immediately following the STACH stay constituted the treatment group.  We used propensity score matching to construct a comparison group consisting of patients with similar characteristics receiving care in other LTCHs after a STACH stay.  Among patients who were discharged with MS-DRG 3 from a STACH, those treated in RML had lower mortality and Medicare payments over 180-day episodes starting with admission to the STACH (p<0.05) compared to similar patients treated in other regional LTCHs.  RML patients with a STACH MS-DRG of 4 had similar 180-day mortality (p>0.05) but lower 180-day Medicare payments (p<0.05) compared to similar patients treated in other regional LTCHs.  The differences in readmission rates between RML patients and similar patients cared for in other regional LTCHs were not statistically significant (p>0.05).

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