Urinary incontinence in subacute care--a retrospective analysis of clinical outcomes and costs.
OBJECTIVE
To investigate the effect of incontinence on clinical outcomes and costs for patients in subacute care.


METHODS
Retrospective analysis of data collected over a 3-month period in 1996.


METHODS
54 medical facilities in Australia and New Zealand providing subacute care in an inpatient setting.


METHODS
6773 episodes of care provided to 6455 rehabilitation and geriatric evaluation and management patients.


METHODS
Urinary continence status, treatment outcomes, length of stay, discharge destination, and nursing and allied healthcare costs.


RESULTS
Discharge destination differed between incontinent and continent patients (57% compared with 82%, respectively, discharged home, and 29% compared with 12%, respectively, discharged to a nursing home or to further care). There was a difference in cost between patients who were continent and those who were incontinent throughout their episode of care (rehabilitation: $185.60 [95% CI, $181-$190] per day for incontinent and $156.82 [95% CI, $153-$160] for continent patients; and geriatric evaluation and management: $164.62 [95% CI, $157-$172] for incontinent and $121.40 [95% CI, $114-$129] for continent patients). However, multilevel analyses showed that, after allowing for age and level of functional independence, the contribution of continence status to the cost of care depended on the functional independence of the patient (cognitive function for orthopaedic patients [P < 0.01] and motor function for stroke patients [P = 0.04]).


CONCLUSIONS
The relationship between continence status and cost of care is complex. However, the cost differences found in our study need to be considered in payment systems, allocation of staff levels on wards and in development of casemix classifications.
Green
Janette P
JP
Centre for Health Service Development, University of Wollongong, Wollongong, NSW 2522, Australia. janette@uow.edu.au
Smoker
Irenie
I
Ho
Maria Theresa
MT
Moore
Kate H
KH
D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D009520:New Zealand; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D019467:Subacute Care / Q000191:economics*; D014549:Urinary Incontinence / Q000191:economics*