Our data show that outcome in the LTAC setting can be predicted from age and number of residual OSFs present at admission to the LTAC hospital. Our OSF score is a simple assessment that requires few laboratory values and appears to be a good discriminator of survivors and decedents. 

Long-term care hospitals were originally founded to care for patients with chronic illness in need of extended care. They have evolved over the past 2 decades to fill a need created by the Health Care Finance Administration implementation of a prospective payment system to acute care hospitals. This system of reimbursement made it financially difficult for acute care hospitals to continue to deliver care to increasing numbers of patients surviving catastrophic critical illness with multiple complex medical problems requiring prolonged hospitalization. Hence, long-term hospitals have developed to assume the post-ICU care of these patients, and have become known as long-term acute care hospitals.

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Because of the typically long length of stay of their patients, LTAC hospitals have been exempt from a prospective payment system, and reimbursement is based on the Tax Equity and Fiscal Responsibility Act cost-basis reimbursement. The LTAC hospital is, by design, intended to deliver care to high-acuity, medically complex patients more efficiently in part by concentrating patients with similar needs in one geographic location. Over the 6-year period from 1990 to 1996, the number of LTAC hospitals increased 106%, from 90 to 185 hospitals.

It is important to differentiate groups of patients being cared for in the LTAC setting. Some patients are transferred with the goal of continued recovery from catastrophic illness with a return to previous level of independence and home discharge. Others are transferred, despite a very low potential for continued recovery, primarily to unburden the acute care hospital ICUs. In these cases, potential for recovery may be uncertain at the time of transfer.

Alternatively, the health-care team, patients, and or families may have unrealistic goals and expectations leading to a continued desire for aggressive medical care Viagra. An emerging literature describing the experiences of patients undergoing critical care brings us recognition of the pain and suffering associated with its administration. The number of patients in our facilities who were receiving mechanical ventilation and required instrumentation suggest that their care was similarly burdened.