Home and Community Care Digest

Home and Community Care Digest September 2005 : 0-0

Nursing home treatment for lower respiratory infection is safe and less costly than hospitalization


Lower respiratory infection (LRI) is the leading cause of hospitalization for nursing home residents, but hospitalization is costly and may cause complications. The authors sought to compare mortality and cost between episodes of LRI initially treated in the hospital versus in the nursing home after controlling for illness severity and the probability of hospitalization. It was found that for residents with low and medium mortality risk, nursing home treatment is likely to be safe and less expensive.
Background:Lower respiratory infections (LRIs), such as pneumonia and bronchitis, are a significant cause of morbidity, mortality and hospitalization among nursing home residents. It is important to assess the potential benefit of hospitalization of residents with an LRI because the hospitalization of older adults is commonly associated with complications and may increase the risk of subsequent functional and cognitive decline. This study determines whether, after controlling for illness acuity and tendency to be hospitalized, initial treatment in the hospital alters the risk of 30-day mortality from LRI. Also examined was the impact of initial treatment setting on the cost of LRI care.

Methods: Data were collected from residents of 36 Missouri nursing homes who had an LRI between 1995 and 1998. The study compared mortality and cost of over 1,000 LRI episodes initially treated in the hospital (those hospitalized within 24 hours of evaluation who had received no antibiotic in the nursing home in the 2 days before evaluating) with those treated in the nursing home. The researchers adjusted for 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.

Findings: After controlling for residents' probability of hospitalization and illness severity, residents who were treated at the nursing home were not significantly more or less likely to die than those who were hospitalized for LRI (odds ratio 0.89 and 1.0 for 30-day mortality; where 1 is equal odds). In addition, nursing home treatment was less costly, with a mean daily cost of over 30 days of $138.24 (USD) for initial nursing home treatment compared with $419.75 (USD) for hospital treatment (i.e., a savings of 67%). Of residents who died, 75.4% were initially in the hospital. It was noted that aggressive therapy may not be appropriate for some frail nursing home residents, and hospitalization may lead to complications

Conclusion: The researchers concluded that for nursing home residents at low or medium risk of death of LRI, nursing home treatment is likely to be safe and less costly than hospitalization. Their findings revealed an overall LRI mortality rate of 14.7%, with 24.7% mortality for episodes initially treated in the hospital and 13.1% for episodes initially treated in the nursing home.

Reference: Kruse RL, Mehr, DR., Boles, KE, Lave, JR, Binder, EF, Madsen, R, D'Agostino, RB. "Does Hospitalization Impact Survival After Lower Respiratory Infection in Nursing Home Residents." Medical Care, September 2004, 42(9): 860-871.


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