An analysis of clinical outcomes and costs of a long term acute care hospital

Figures & data

Table 1.  Patient characteristics.

	Control group	LTCH group
Sample size	187	196
Gender (male/female) %	48.1/51.9	58.7/41.3
Average age	63.35	70.0
Average No. of co-morbidities	8.5	8.5
Average length of stay (days)	37.5	33.0

Table 2.  Clinical outcomes.

Outcome		Control group	LTCH group
Mortality	Deceased/alive	33/154	26/170
	% Deceased	17.60%	13.3%
Home discharge	Home/elsewhere	20/167	61/135
	% Home	10.7%	31.1%
SNF discharge	SNF/elsewhere	73/114	40/156
	% SNF	39.0%	20.4%

Mortality: The Z-test for the difference in true proportions yields: Z-test statistic = 1.1874, p-value = 0.235, not significant. The chi-square test for independence yields: Chi-square = 1.410, df = 1, p-value = 0.235, not significant.

Home discharge: The Z-test for the difference in true proportions yields: Z-test statistic = 4.8934, p-value = 0.000001, significant. The chi-square test for independence yields: Chi-square = 23.946, df = 1, p-value = 0.000001, significant.

SNF discharge: The Z-test for the difference in true proportions yields: Z-test statistic = −3.9960, p-value = 0.00006, significant. The chi-square test for independence yields: Chi-square = 15.968, df = 1, p-value = 0.00006, significant

Table 3.  Comparative costs control group care vs. LTCH group care.

	Mean total cost per patient	Mean daily cost per patient
Control group*	$59,103	$1,520
LTCH group	$36,626	$1,154
Savings of LTCH care ($)	$22,477	$366
Savings of LTCH care (% of control)	38.0%	24.0%

*Source: Hospital for Special Care Long Term Acute Care and St. Francis Medical Center FY 2002 Control Group Data. In FY 2002, average costs per day and per patient were $1,292 and $50,242, respectively. The two costs were adjusted using the annual growth rate of the Medicare Cost Report 90th percentile cost per discharge for the last four years to obtain rates for FY 2006.

Table

	Mean	Standard deviation	Min	First quartile	Median	Third quartile	Max
LTACH daily cost	1,154	376	291	895	1,135	1,318	3,182
Control daily cost	1,520	559	428	1,116	1,411	1,877	3,398

T-test for the difference in the means (LTACH – control) equal to zero: t-test statistic = −7.50, p-value ≈ 0, significant. 95% t confidence interval: (−462.5, −270.3), significant.

Mann–Whitney (nonparametric) test for the difference in the medians (LTACH – control) equal to zero: W-test statistic = 30,172.5, p-value ≈ 0, significant. 95% Mann–Whitney interval for the difference in the medians: (−409, −226), significant.

Table 4.  Comparative costs for acute care and LTCH care of SFMHC patients transferred from SFHMC acute care to LTCH care*.

	Mean total cost per patient	Mean daily cost per patient
Acute care before LTCH admission	$51,724	$2,365
Mean length of stay = 19.5 days
LTCH care	$33,131	$1,154
Mean length of stay = 29.1 days
Difference between acute care and LTCH care	$18,592†	$1,211

*Comparative costs for acute care and LTCH care of SFHMC patients transferred from SFHMC acute care to LTCH during the 24 month study period; n = 114.

†Difference in mean total cost per patient between acute care and LTCH care is due in part to the differences in mean lengths of stay.

Since the data are paired, a single sample set of the differences in cost per day (SFC – LTAC) for each patient was created for statistical analysis.

Table

	Mean	Median	Min	Max	Standard deviation
Difference in cost per day (SFH – LTAC)	1,211	1,752	−374	17,374	1,752

T-test for the mean difference equal to zero: T-test statistic = 7.41, p-value = 0.00000000002, significant. 95% t confidence interval: (887, 1535), significant.

Sign (nonparametric) test for the median difference equal to zero: Z-test statistic = −9.325, with a p-value ≈ 0, significant. 95% sign interval for the median difference: (717, 1248), significant.

Wilcoxon (nonparametric) test for the median difference equal to zero: W-test statistic = 6580, with a p-value ≈ 0, significant. 95% Wilcoxon interval for the median difference: (860, 1214), significant.