title: The cost of treating pneumonia in the nursing home setting.
abstract: OBJECTIVE
  To determine the costs of treating pneumonia in the nursing home setting and explore what factors are most responsible for that cost with a view to reducing cost.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Thirty-six Missouri nursing homes participating in the study from April 1997 through September 1998.
  
  
  METHODS
  Nursing home residents with pneumonia who were not hospitalized (n = 502). We included residents evaluated in the emergency department (ED) and returned to the nursing home without admission.
  
  
  METHODS
  Residents were evaluated by project nurses. Examination findings, diagnostic testing, and treatment information for 30 days following evaluation were abstracted from medical records. Bills were obtained for individuals evaluated in the ED.
  
  
  RESULTS
  There was significant variation in the cost of treating pneumonia in nursing homes. Episode costs were higher for residents seen in the ED of a hospital, residents with decubitus ulcers, black residents, and residents in larger facilities. Although total episode costs were related to illness severity, most of the variation in cost is not explained by resident or illness characteristics. The average cost for treating an episode of pneumonia in the nursing home, over and above usual care, was $458.
  
  
  CONCLUSIONS
  There is wide variation in treatment for residents with similar clinical presentations. For residents at low risk of mortality, using less expensive antibiotics and reducing ED evaluation could result in cost reductions, although the effect on outcomes is unknown.
authors.affiliation: Department of Family and Community Medicine, University of Missouri-Columbia, MO, USA.
authors.forename: Robin L
authors.initials: RL
authors.lastname: Kruse
authors.forename: Keith E
authors.initials: KE
authors.lastname: Boles
authors.forename: David R
authors.initials: DR
authors.lastname: Mehr
authors.forename: Diane
authors.initials: D
authors.lastname: Spalding
authors.forename: Judith R
authors.initials: JR
authors.lastname: Lave
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006707:Homes for the Aged / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D009735:Nursing Homes / Q000191:economics*; D017063:Outcome Assessment, Health Care; D018410:Pneumonia, Bacterial / Q000191:economics* / Q000628:therapy*; D011446:Prospective Studies; D012107:Research Design; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents