Accuracy of the discharge destination field in administrative data for identifying transfer to a long-term acute care hospital

We used the 2006 hospitalization claims for United States Medicare beneficiaries to examine the performance characteristics of the discharge destination field in the administrative record, compared to the reference standard of directly observing LTAC transfers in the claims. We found that the discharge destination field was highly specific (99.7%, 95 percent CI: 99.7% - 99.8%) but modestly sensitive (77.3%, 95 percent CI: 77.0% - 77.6%), with corresponding low positive predictive value (72.6%, 95 percent CI: 72.3% - 72.9%) and high negative predictive value (99.8%, 95 percent CI: 99.8% - 99.8%). Sensitivity and specificity were similar when limiting the analysis to only intensive care unit patients and mechanically ventilated patients, two groups with higher rates of LTAC utilization. Performance characteristics were slightly better when limiting the analysis to Pennsylvania, a state with relatively high LTAC penetration.The discharge destination field in administrative data can result in misclassification when used to identify patients transferred to long-term acute care hospitals. Directly observing transfers in the claims is the preferable method, although this approach is only feasible in identified data.Long-term acute care (LTAC) hospitals specialize in the care of severely ill hospitalized patients with longer than average lengths of stay [1]. Typically LTACs provide care for patients with complex care needs after an episode of severe acute illness, such as patients requiring intensive wound care or prolonged mechanical ventilation [2]. LTACs are among the fastest growing segments of the US health care system, increasing at an average rate of approximately 10% per year [3]. Despite such growth, it is not clear whether or not LTACs provide value over the alternatives sites of care such as skilled nursing facilities, rehabilitation hospitals, or intermediate care units within acute care hospitals [4]. Research is needed to examine the factors related to LTAC ut