Association between Residential Segregation and Long-Term Acute Care Hospital Performance on Improvement in Function among Ventilated Patients

Abstract

One in five survivors of critical illness who require prolonged mechanical ventilation are discharged to long-term acute care hospitals (LTCHs). Although disparities based on race and insurance have been described in LTCH use, studies have not evaluated equity in outcomes. Improvement in function (e.g., mobility) is a crucial recovery goal for patients requiring prolonged mechanical ventilation. Research in other areas has suggested that Black patients disproportionately receive care in lower-performing facilities. Whether LTCHs serving communities with more segregation achieve lower gains in functional outcomes is unknown. In response to the Improving Medicare Post-Acute Care Transformation Act, the Centers for Medicare and Medicaid Services mandated reporting of change in mobility among ventilated patients as an LTCH quality measure. We sought to examine the association between the racial composition of the neighborhood and county of an LTCH and performance on the functional mobility improvement measure.