Dr. Jeremy Kahn recently received an R01 grant for his project, “Identifying Optimal Care Structures and Processes in Long-Term Acute Care Hospitals.” Long-term acute care hospitals (LTACs) are specialized facilities designed to provide care to patients with chronic critical illness. The DELTA (Determinants of Effective Long Term Acute Care) study builds off of Dr. Kahn’s prior work by looking within LTACs to identify the key structures and processes associated with patient survival. DELTA will begin in December 2014 and last until December 2018.
In Dr. Kahn’s prior award (R01HL096651), the research team demonstrated that patients with chronic critical illness admitted to LTACs experience similar survival as those who remain in acute care ICUs, but with lower total costs. Yet, they also found wide variation in risk-adjusted survival across LTACs, with differences in long-term mortality not explained by differences in case mix. Together, these findings demonstrate that although LTACs can and should play a continuing role in the US health care system, it is essential to identify ways to best deliver care within LTACs in order to optimize patient outcomes.
DELTA will use an innovative mixed-methods approach to identify the clinical and organizational factors associated with LTAC performance. Over the next four years, the research team will visit both high and low quality LTACs, performing detailed site visits to determine the “best practices” associated with improved survival among patients with chronic critical illness. The results will provide clinicians, hospitals, and policy makers with actionable data on how to best organize LTACs to improve outcomes for these high risk, high cost patients.
Jeremy M. Kahn, MD, MS, is Associate Professor of Critical Care, Medicine and Health Policy in the University of Pittsburgh School of Medicine and Graduate School of Public Health, and Director of the CRISMA Program on Health Policy and Management.