Home and Community Care Digest
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.
Be the first to comment on this!
Personal Subscriber? Sign In
Note: Please enter a display name. Your email address will not be publically displayed