The Effects of Long-Term Care Hospitals on Medical Spending and Patient Outcomes: A Review of the Literature

For the National Association of Long Term Hospitals (NALTH), we conducted a systematic literature review on the effectiveness of receiving care in a long-term care hospital (LTCH).  We limited the search to studies published in English between January 1990 and August 2017. In addition to articles indexed in PubMed, we supplemented our review with reports from government agencies, studies from consultants and other subject matter experts, and articles identified from references of relevant published articles.  Our review identified only eight peer-reviewed studies assessing the impact of receiving care in an LTCH on spending and patient outcomes that met our inclusion and exclusion criteria and an additional six reports from government, consulting, and other entities. Among the 14 total publications, nine were comparative studies, which examined outcomes between patients treated in LTCHs and those in other settings. The literature supports the positive effects of LTCH care in terms of mortality, Medicare spending, and provider costs for some patient groups, particularly among the highest severity patients, such as those with extended ICU stays, those on a ventilator or with a tracheostomy, and those patients with multiple organ failure. However, the variability in results indicates the need for more research to better identify which patients are the best candidates for receiving care in an LTCH and what characteristics of LTCH care yield positive outcomes for patients.

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