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Risk Assessment for Inpatient Survival in the Long-term Acute Care Setting After Prolonged Critical Illness^*

^* From the Department of Medicine, Division of Pulmonary and Critical Care (Drs. Dematte D’Amico and Mutlu, and Ms. Donnelly) and Department of Preventive Medicine (Drs. Feinglass and Jovanovic), Northwestern University Feinberg School of Medicine, Chicago, IL; and The Medical Group of Michigan City, PC (Dr. Ndukwu), Michigan City, IN.

Correspondence to: Jane E. Dematte D’Amico, MD, FCCP, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave, Tarry 14-707, Chicago IL 60611; e-mail: j-dematte{at}northwestern.edu

Objective: The past decade has witnessed growth in the long-term acute care (LTAC) hospital industry. There are no reliable risk assessment models that can adjust outcomes across such facilities with different criteria for admitting patients. Variation in reported outcomes makes it difficult to determine whether a patient, or group of patients, may benefit from such care. This study sought to determine the extent to which survival in the LTAC setting is associated with age, race, residual organ system failures (OSFs), or APACHE (acute physiology and chronic health evaluation) III scores at the time of admission to LTAC.

Design: Retrospective medical record review.

Setting: Four freestanding facilities of a LTAC hospital.

Patients: A sample of 300 hospital admissions weighted to represent the study hospital population.

Measurements: Inpatient survival modeled as a function of age, APACHE III score calculated within 72 h prior to LTAC admission, and residual OSFs present on admission to LTAC.

Results: Logistic regression analysis shows age and OSF were most predictive of inpatient survival (receiver operating characteristic curve area = 0.81). APACHE III score was not predictive of survival in the multivariate model.

Conclusions: Survival in LTAC is primarily associated with age and OSFs, which should be used to adjust for patient populations among LTAC settings when comparing outcomes. Our model identifies a group of patients with the poorest likelihood of survival in the LTAC setting, and may be used to facilitate dialogue with patients and family in cases where continued aggressive care is least effective.

Key Words: acute physiology and chronic health evaluation • long-term acute care • multiple organ failure • risk assessment

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