Incidence and costs of acute medical conditions in long-stay incontinent nursing home residents.
OBJECTIVE
To determine the incidence of acute medical conditions in incontinent nursing home residents, and associated costs of diagnostic testing and treatment


METHODS
Prospective, cohort study.


METHODS
Three community nursing homes.


METHODS
161 long-stay residents with urinary incontinence in (mean age 86 years, 77% female, 92% white).


METHODS
Acute medical conditions were identified prospectively through medical record review based on standardized criteria. All diagnostic testing and treatment provided for these conditions were recorded, and related costs in the nursing home were assigned based on 1997-1998 Medicare and Medicaid reimbursement.


RESULTS
The highest incidences of illness were for dermatological conditions (107 episodes per 1000 patient-weeks, involving 70% of subjects), respiratory illnesses (29 per 1000 patient-weeks, 47% of subjects) and gastrointestinal illnesses (24 per 1000 patient-weeks, 36% of subjects). Among episodes with an incidence of at least 5 per 1000 patient-weeks, the illness events with the highest median diagnostic testing and treatment costs per episode were pneumonia, acute bronchitis, and depression. Only 42 out of the total 1071 episodes identified resulted in a hospitalization. Significant predictors of higher illness incidence included greater baseline comorbidity and higher number of routine medications (model adjusted R-square = 0.319, P = 0.021).


CONCLUSIONS
Acute illness is very common among incontinent nursing home residents, and is generally diagnosed and treated at the nursing home site, with variation among conditions in associated costs. Important policy implications include resource allocation (including appropriate staffing patterns), educational and quality improvement activities, and future research and guideline development for the optimal management of medical conditions in the nursing home setting.
Alessi
Cathy A
CA
University of California at Los Angeles Multicampus Program in Geriatric Medicine and Gerontology, and Veterans Administration Greater Los Angeles Healthcare System, Sepulveda Geriatric Research, Education and Clinical Center, USA. calessi@ucla.edu
Ouslander
Joseph G
JG
Maldague
Sandra
S
Al-Samarrai
Nahla R
NR
Saliba
Debra
D
Osterweil
Dan
D
Beck
John C
JC
Schnelle
John F
JF