title: Trends in Long-Term Acute Care Hospital Use in Texas from 2002-2011.
abstract: OBJECTIVE
  To assess regional trends in long-term acute care hospital (LTAC) use over time.
  
  
  METHODS
  Retrospective study using 100% Texas Medicare data. Separate cohorts were created for each year from 2002-2011, which included all beneficiaries residing in 23 hospital referral regions (HRRs) with continuous enrollment in Parts A and B in the previous and current year, or until death.
  
  
  METHODS
  LTAC utilization rate was defined as the number of individuals with a LTAC stay per 100,000 Medicare beneficiaries residing in the HRR. Baseline LTAC use at the HRR-level was categorized by tertiles of use in 2002.
  
  
  RESULTS
  Overall, LTAC use increased 35% from 2002-2011 and coincided with major Medicare policy changes. However, there were marked regional differences in LTAC utilization trends. From 2002-2011, HRRs in the lowest tertile of baseline LTAC use, which included regions with 0 to 1 LTAC facilities in 2002, had an increase in utilization by 211%, from 190 to 591 individuals per 100,000 persons. In contrast, HRRs in the highest tertile of baseline LTAC use, which included some of the most densely LTAC-bedded regions in the country, experienced a 21% decline (915 to 719 individuals per 100,000 persons; p<0.001 for interaction of LTAC utilization and tertile of baseline use).
  
  
  CONCLUSIONS
  These findings suggest substantial regional variation in the trends in LTAC use over time. Further research is needed to estimate how much of this variation is due to differences in clinical need due to increasing number of severely ill older adults versus regional market supply.
authors.affiliation: Division of General Internal Medicine, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Anil N
authors.initials: AN
authors.lastname: Makam
authors.affiliation: Sealy Center on Aging, University of Texas Medical Branch, Galveston TX.
authors.forename: Oanh K
authors.initials: OK
authors.lastname: Nguyen
authors.affiliation: Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston TX.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhou
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Ottenbacher
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Halm
keywords: Medicare; health services research; hospitals; long-term care; utilization