In a new study published in BMC Pulmonary Medicine, researchers found that earlier transfer of mechanically ventilated patients to long-term care hospitals (LTCHs) increased the likelihood of being liberated from the ventilator. The study demonstrates the crucial role served by these specialty hospitals in caring for the most severely ill and medically complex patients.
As advances in medicine have increased the survival of patients undergoing care in intensive care units, the number of patients who receive life-saving mechanical ventilator care has grown. Patients who spend extended time on a ventilator may become dependent on these devices, negatively impacting their quality of life. Frequently, these patients are admitted to an LTCH following treatment in a short-term acute care hospital (STACH) to wean from the ventilator and continue their recovery. To be certified as an LTCH under Medicare, these hospitals must meet all the requirements of a STACH and have an average length of stay of 25 days or more. LTCHs have specialized weaning protocols and trained staff to help patients free themselves from a ventilator and recover from their critical illnesses.
Using Medicare claims and assessment data, the study examined weaning rates and mortality for a cohort of 13,622 Traditional Medicare patients that had endotracheal intubation in the STACH and were transferred to an LTCH. After controlling for patient complexity, the researchers found that for each day a patient is discharged earlier from a STACH to an LTCH, the likelihood of the patient successfully weaning from the ventilator increases by 2.5 percentage points. The study found no statistically significant relationship between time from intubation to LTCH admission and 90-day mortality.
The study, which was funded by the National Association of Long Term Hospitals (NALTH), notes that clinical guidelines used by Medicare Advantage and other private insurance plans often establish that a patient stay at least 21 days in a STACH before approval of transfer to an LTCH. The study findings raise questions as to the clinical value of “test of time” approaches, according to the authors. “The study confirms the importance of LTCHs as a care setting and should inform clinical treatment decisions for ventilated patients,” observed Dr. Ed Prettyman, CEO of TexasNeuro Rehab Center and President of NALTH.