The Clinical Course after Long-Term Acute Care Hospital Admission among Older Medicare Beneficiaries.
Aged
Aged, 80 and over
Cause of Death
/ trends
Critical Illness
/ epidemiology
Fee-for-Service Plans
/ statistics & numerical data
Female
Follow-Up Studies
Hospitalization
/ trends
Humans
Long-Term Care
/ economics
Male
Medicare
/ economics
Palliative Care
/ economics
Patient Transfer
Retrospective Studies
Risk Assessment
/ methods
Subacute Care
/ economics
Survival Rate
/ trends
Time Factors
United States
/ epidemiology
Medicare
older adults
palliative care
post-acute care
prognosis
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
17
04
2019
revised:
03
07
2019
accepted:
05
07
2019
pubmed:
27
8
2019
medline:
22
5
2020
entrez:
27
8
2019
Statut:
ppublish
Résumé
Long-term acute care (LTAC) hospitals provide extended complex post-acute care to more than 120 000 Medicare beneficiaries annually, with the goal of helping patients to regain independence and recover. Because little is known about patients' long-term outcomes, we sought to examine the clinical course after LTAC admission. Nationally representative 5-year cohort study using 5% Medicare data from 2009 to 2013. LTAC hospitals. Hospitalized Medicare fee-for-service beneficiaries 65 years of age or older who were transferred to an LTAC hospital. Mortality, recovery (defined as achieving 60 consecutive days alive without inpatient care), time spent in an inpatient facility following LTAC hospital admission, receipt of an artificial life-prolonging procedure (feeding tube, tracheostomy, hemodialysis), and palliative care physician consultation. Of 14 072 hospitalized older adults transferred to an LTAC hospital, median survival was 8.3 months, and 1- and 5-year survival rates were 45% and 18%, respectively. Following LTAC admission, 53% never achieved a 60-day recovery. The median time of their remaining life a patient spent as an inpatient after LTAC admission was 65.6% (interquartile range = 21.4%-100%). More than one-third (36.9%) died in an inpatient setting, never returning home after the LTAC admission. During the preceding hospitalization and index LTAC admission, 30.9% received an artificial life-prolonging procedure, and 1% had a palliative care physician consultation. Hospitalized older adults transferred to LTAC hospitals have poor survival, spend most of their remaining life as an inpatient, and frequently undergo life-prolonging procedures. This prognostic understanding is essential to inform goals of care discussions and prioritize healthcare needs for hospitalized older adults admitted to LTAC hospitals. Given the exceedingly low rates of palliative care consultations, future research is needed to examine unmet palliative care needs in this population. J Am Geriatr Soc 67:2282-2288, 2019.
Types de publication
Journal Article
Multicenter Study
Observational Study
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
2282-2288Subventions
Organisme : NIA NIH HHS
ID : K23AG052603
Pays : United States
Organisme : NIA NIH HHS
ID : R03AG053291
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1TR001105
Pays : United States
Organisme : NHLBI NIH HHS
ID : K23HL133441
Pays : United States
Organisme : Agency for Healthcare Research & Quality
ID : R24HS022418
Pays : International
Organisme : Agency for Healthcare Research and Quality
ID : R24HS022418
Pays : International
Organisme : NCATS NIH HHS
ID : UL1TR001105
Pays : United States
Organisme : NHLBI NIH HHS
ID : K23HL133441
Pays : United States
Organisme : NIA NIH HHS
ID : K23AG052603
Pays : United States
Organisme : NIA NIH HHS
ID : R03AG053291
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2019 The American Geriatrics Society.
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