Direct costs associated with the appropriateness of hospital stay in elderly population

BackgroundThe impact of delayed discharge on patients, health‐care staff and hospital costs has been incompletely characterized.AimTo systematically review experiences of delay from the perspectives of patients, health professionals and hospitals, and its impact on patients’ outcomes and costs.MethodsFour of the main biomedical databases were searched for the period 2000‐2016 (February). Quantitative, qualitative and health economic studies conducted in OECD countries were included.ResultsThirty‐seven papers reporting data on 35 studies were identified: 10 quantitative, 8 qualitative and 19 exploring costs. Seven of ten quantitative studies were at moderate/low methodological quality; 6 qualitative studies were deemed reliable; and the 19 studies on costs were of moderate quality. Delayed discharge was associated with mortality, infections, depression, reductions in patients’ mobility and their daily activities. The qualitative studies highlighted the pressure to reduce discharge delays on staff stress and interprofessional relationships, with implications for patient care and well‐being. Extra bed‐days could account for up to 30.7% of total costs and cause cancellations of elective operations, treatment delay and repercussions for subsequent services, especially for elderly patients.ConclusionsThe poor quality of the majority of the research means that implications for practice should be cautiously made. However, the results suggest that the adverse effects of delayed discharge are both direct (through increased opportunities for patients to acquire avoidable ill health) and indirect, secondary to the pressures placed on staff. These findings provide impetus to take a more holistic perspective to addressing delayed discharge.

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“…At least 4 studies referred to the cost of inappropriate admissions for specific health conditions of surgical procedures …”

Section: Resultsmentioning

confidence: 99%

Impact and experiences of delayed discharge: A mixed‐studies systematic review

Rojas-García

Turner

Pizzo

et al. 2017

Health Expectations

216

205

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“…In our study, the median length of hospital stay in the total cohort was 9.0 (4.0;16.0) days which is comparable to other older patient cohorts. The median stay in hospital was between 5 and 14 days in older patients admitted to geriatric and internal medicine wards [8,17,22,43,44]. In a previous study analyzing 419 patients aged ≥70 years from geriatric wards [28], higher age, number of admission diagnoses, incontinence, and ADL impairment predicted a longer hospital stay.…”

Section: Comparison With Literature Length Of Hospital Staymentioning

confidence: 94%

“…The need of intensified medical care in older patients as reflected by prolonged length of hospital stay, more nursing hours and patients receiving physiotherapy challenges personnel and financial resources [8,17,18]. Previous studies have shown that prolonged length of hospital stay is predicted by factors including female sex and polypharmacy in patients aged ≥65 years admitted to acute internal and geriatric wards [8] and by age ≥ 60 and higher number of comorbidities in colon cancer patients aged < 60 to > 80 years [19].…”

Section: Introductionmentioning

confidence: 99%

Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline

Scharf,

Gronewold,

Dahlmann

et al. 2020

BMC Geriatr

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Background: The rising number of older multimorbid in-patients has implications for medical care. There is a growing need for the identification of factors predicting the needs of older patients in hospital environments. Our aim was to evaluate the use of clinical and functional patient characteristics for the prediction of medical needs in older hospitalized patients. Methods: Two hundred forty-two in-patients (57.4% male) aged 78.4 ± 6.4 years, who were consecutively admitted to internal medicine departments of the University Hospital Essen between July 2015 and February 2017, were prospectively enrolled. Patients were assessed upon admission using the Identification of Seniors at Risk (ISAR) screening followed by comprehensive geriatric assessment (CGA). The CGA included standardized instruments for the assessment of activities of daily living (ADL), cognition, mobility, and signs of depression upon admission. In multivariable regressions we evaluated the association of clinical patient characteristics, the ISAR score and CGA results with length of hospital stay, number of nursing hours and receiving physiotherapy as indicators for medical needs. We identified clinical characteristics and risk factors associated with higher medical needs. Results: The 242 patients spent [median(Q1;Q3)]:9.0(4.0;16.0) days in the hospital, needed 2.0(1.5;2.7) hours of nursing each day, and 34.3% received physiotherapy. In multivariable regression analyses including clinical patient characteristics, ISAR and CGA domains, the factors age (β = − 0.19, 95% confidence interval (CI) = − 0.66;-0.13), number of admission diagnoses (β = 0.28, 95% CI = 0.16;0.41), ADL impairment (B = 6.66, 95% CI = 3.312;10.01), and signs of depression (B = 6.69, 95% CI = 1.43;11.94) independently predicted length of hospital stay. ADL impairment (B = 1.14, 95%CI = 0.67;1.61), cognition impairment (B = 0.57, 95% CI = 0.07;1.07) and ISAR score (β =0.26, 95% CI = 0.01;0.28) independently predicted nursing hours. The number of admission diagnoses (risk ratio (RR) = 1.06, 95% CI = 1.04;1.08), ADL impairment (RR = 3.54, 95% CI = 2.29;5.47), cognition impairment (RR = 1.77, 95% CI = 1.20;2.62) and signs of depression (RR = 1.99, 95% CI = 1.39;2.85) predicted receiving physiotherapy. Conclusion: Among older in-patients at risk for functional decline, the number of comorbidities, reduced ADL, cognition impairment and signs of depression are important predictors of length of hospital stay, nursing hours, and receiving physiotherapy during hospital stay.

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“…In our study, the median length of hospital stay in the total cohort was 9.0 (4.0;16.0) days which is comparable to other older patient cohorts. The median stay in hospital was between 5-14 days in older patients admitted to geriatric and internal medicine wards [8,17,22,43,44]. In a previous study analyzing 419 patients aged ≥70 years from geriatric wards [28], higher age, number of admission diagnoses, incontinence, and ADL impairment predicted a longer hospital stay.…”

Section: Length Of Hospital Staymentioning

confidence: 99%

Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline

Scharf

Gronewold

Dahlmann

et al. 2020

Preprint

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Background: The rising number of older multimorbid in-patients has implications for medical care. There is a growing need for the identification of factors predicting the needs of older patients in hospital environments. Our aim was to evaluate the use of clinical and functional patient characteristics for the prediction of medical needs in older hospitalized patients. Methods: 242 in-patients (57.4% male) aged 78.4±6.4 years, who were consecutively admitted to internal medicine departments of the University Hospital Essen between July 2015 and February 2017, were prospectively enrolled. Patients were assessed upon admission using the Identification of Seniors at Risk (ISAR) screening followed by comprehensive geriatric assessment (CGA). The CGA included standardized instruments for the assessment of activities of daily living (ADL), cognition, mobility, and signs of depression upon admission. In multivariable regressions we evaluated the association of clinical patient characteristics, the ISAR score and CGA results with length of hospital stay, number of nursing hours and receiving physiotherapy as indicators for medical needs. We identified clinical characteristics and risk factors associated with higher medical needs. Results: The 242 patients spent [median(Q1;Q3)]:9.0(4.0;16.0) days in the hospital, needed 2.0(1.5;2.7) hours of nursing each day, and 34.3% received physiotherapy. In multivariable regression analyses including clinical patient characteristics, ISAR and CGA domains, the factors age (β=-0.19, 95% confidence interval (CI)=-0.66;-0.13), number of admission diagnoses (β=0.28, 95%CI=0.16;0.41), ADL impairment (B=6.66, 95%CI=3.312;10.01), and signs of depression (B=6.69, 95%CI=1.43;11.94) independently predicted length of hospital stay. ADL impairment (B=1.14, 95%CI=0.67;1.61), cognition impairment (B=0.57, 95%CI=0.07;1.07) and ISAR score (β =0.26, 95%CI=0.01;0.28) independently predicted nursing hours. The number of admission diagnoses (risk ratio (RR)=1.06, 95%CI=1.04;1.08), ADL impairment (RR=3.54, 95%CI=2.29;5.47), cognition impairment (RR=1.77, 95%CI=1.20;2.62) and signs of depression (RR=1.99, 95%CI=1.39;2.85) predicted receiving physiotherapy. Conclusion: Among older in-patients at risk for functional decline, the number of comorbidities, reduced ADL, cognition impairment and signs of depression are important predictors of length of hospital stay, nursing hours, and receiving physiotherapy during hospital stay.

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Direct costs associated with the appropriateness of hospital stay in elderly population

Abstract: Background: Ageing of Mexican population implies greater demand of hospital services. Nevertheless, the available resources are used inadequately. In this study, the direct medical costs associated with the appropriateness of elderly populations hospital stay are estimated.

Cited by 22 publications

References 21 publications

Impact and experiences of delayed discharge: A mixed‐studies systematic review

Impact and experiences of delayed discharge: A mixed‐studies systematic review

Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline

Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline

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