Predicting excess cost for older inpatients with clinical complexity: A retrospective cohort study examining cognition, comorbidities and complications

Abstract

BackgroundHospital-acquired complications increase length of stay and contribute to poorer patient outcomes. Older adults are known to be at risk for four key hospital-acquired complications (pressure injuries, pneumonia, urinary tract infections and delirium). These complications have been identified as sensitive to nursing characteristics such as staffing levels and level of education. The cost of these complications compared to the cost of admission severity, dementia, other comorbidities or age has not been established.MethodTo investigate costs associated with nurse-sensitive hospital-acquired complications in an older patient population 157,178 overnight public hospital episodes for all patients over age 50 from one Australian state, 2006/07 were examined. A retrospective cohort study design with linear regression analysis provided modelling of length-of-stay costs. Explanatory variables included patient age, sex, comorbidities, admission severity, dementia status, surgical status and four complications. Extra costs were based on above-average length-of-stay for each patient’s Diagnosis Related Group from hospital discharge data.ResultsFor adults over 50 who have length of stay longer than average for their diagnostic condition, comorbid dementia predicts an extra cost of A$874, (US$1,247); any one of four key complications predicts A$812 (US$1,159); each increase in admission severity score predicts A$295 ($US421); each additional comorbidity predicts A$259 (US$370), and for each year of age above 50 predicts A$20 (US$29) (all estimates significant at p<0.0001).DiscussionHospital-acquired complications and dementia cost more than other kinds of inpatient complexity, but admission severity is a better predictor of excess cost. Because complications are potentially preventable and dementia care in hospitals can be improved, risk-reduction strategies for common complications, particularly for patients with dementia could be cost effective.ConclusionsComplications and dementia were found to cost more than other kinds of inpatient complexity.

The Frequency and Causes of Physical Complications/ Adverse Events During the Hospitalization of Patients with Dementia

“…Učinak komorbiditetnih dijagnoza se zbraja, a među svim dijagnozama ključna je demencija. Bolesnici s demencijom imaju gotovo dvostruko više komplikacija u odnosu na bolesnike bez demencije (6). Također se u literaturi navodi mogući utjecaj benzodiazepina i antipsihotika na veću sklonost razvoju pneumonije kod hospitaliziranih bolesnika s demencijom, pa je ly difficult to identify in the early stages of the disease (e.g.…”

“…Although somatic conditions are diagnosed immediately upon arrival on the ward in routine laboratory processing and detailed physical examination and patient observation, physical decompensation often occurs due to the rapid development of the clinical picture. Studies have found that the elderly population, when hospitalized, is at an increased risk of hospital complications (falls, pneumonia, urinary tract infections, delirious conditions) (6). Complications lead to longer hospitalization, which again increases the risk of new complications and ultimately poor treatment outcome and higher costs.…”

“…When the effects of comorbidity diagnoses are summed up, dementia is of key importance among all diagnoses. Patients with dementia have almost twice as many complications than patients without dementia (6). The potential impact of benzodiazepines and antipsychotics on the greater risk for developing pneumonia in hospitalized patients with dementia has also been reported, so it is certainly necessary to consider the cost-benefit of their use (11,12).…”

“…pneumonija bez febriliteta) i razvijati se vrlo brzo, neophodno je na vrijeme prepoznati problem (5). Potrebno je naglasiti da kod ovih bolesnika, čak i diskretna promjena u okruženju, a osobito dolazak na akutni odjel, može dodatno nepovoljno utjecati na psihičko i somatsko stanje bolesnika, uzrokovati komplikacije, intenzivno somatsko liječenje, dužu hospitalizaciju i veće troškove (1,2,6).…”

“…pneumonia without febrility) and can develop very quickly, it is necessary to identify the condition timely (5). It should be emphasized that in these patients, even a discrete environmental change, and especially admission to the acute ward, can additionally adversely affect the mental and somatic condition of the patient, causing somatic complications requiring intensive somatic treatment, longer hospitalization, and higher costs (1,2,6 Zbog dekompenziranih tjelesnih stanja koja su zahtijevala premještaj na somatski odjel (drugu bolnicu) u promatranom je razdoblju premješteno 28 % svih bolesnika (40,2 % muškaraca i 23 % žena), a od toga 39 % u prvih sedam dana od dolaska u bolnicu. Prosječno trajanje hospitalizacije u slučaju premještaja u somatsku bolnicu bilo je kod muškaraca 13,7 dana (događalo se od 1. do 60. dana), a kod žena 18,85 dana (događalo se od 1. do 67. dana).…”