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Does hospitalization impact survival after lower respiratory infection in nursing home residents?
- Source :
-
Medical care [Med Care] 2004 Sep; Vol. 42 (9), pp. 860-70. - Publication Year :
- 2004
-
Abstract
- Background: Lower respiratory infection (LRI) is the leading cause of hospitalization for nursing home residents, but hospitalization is costly and may cause complications.<br />Objective: We sought to compare mortality and cost between episodes of LRI initially treated in the hospital versus the nursing home after controlling for illness severity and the probability of hospitalization.<br />Design: This was a prospective cohort study of nursing home residents with LRIs.<br />Subjects: We identified 1406 episodes of LRI in 36 nursing homes in central Missouri and the St. Louis area between August 15, 1995, and September 30, 1998. Economic analysis was restricted to 1033 episodes identified after March 31, 1997.<br />Measures: We adjusted for the higher probability of initial hospitalization in sicker residents using measures of illness severity and a hospitalization propensity score. The propensity score was derived from a logistic regression model that included patient, physician, and facility variables. Estimated costs were attributed to initial treatment setting.<br />Results: After controlling for the probability of hospitalization and illness severity, hospitalization was not a significant mortality predictor (odds ratio 0.89, 95% confidence interval 0.52-1.52). Mean daily cost was $138.24 for initial nursing home treatment and $419.75 for the hospital.<br />Conclusions: After controlling for illness severity and propensity for hospitalization, hospital treatment is not associated with either increased or decreased risk for mortality for nursing home residents with LRIs. For residents with low and medium mortality risk, nursing home treatment is likely to be safe and less costly.
- Subjects :
- Aged
Aged, 80 and over
Cohort Studies
Confidence Intervals
Female
Geriatric Assessment
Homes for the Aged statistics & numerical data
Humans
Logistic Models
Male
Middle Aged
Missouri epidemiology
Nursing Homes statistics & numerical data
Odds Ratio
Outcome Assessment, Health Care
Pneumonia, Bacterial therapy
Prospective Studies
Risk Assessment
Severity of Illness Index
Survival Analysis
Time Factors
Homes for the Aged economics
Length of Stay economics
Nursing Homes economics
Pneumonia, Bacterial economics
Pneumonia, Bacterial mortality
Subjects
Details
- Language :
- English
- ISSN :
- 0025-7079
- Volume :
- 42
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Medical care
- Publication Type :
- Academic Journal
- Accession number :
- 15319611
- Full Text :
- https://doi.org/10.1097/01.mlr.0000135828.95415.b1