Does hospitalization impact survival after lower respiratory infection in nursing home residents?
BACKGROUND
Lower respiratory infection (LRI) is the leading cause of hospitalization for nursing home residents, but hospitalization is costly and may cause complications.


OBJECTIVE
We sought to compare mortality and cost between episodes of LRI initially treated in the hospital versus the nursing home after controlling for illness severity and the probability of hospitalization.


METHODS
This was a prospective cohort study of nursing home residents with LRIs.


METHODS
We identified 1406 episodes of LRI in 36 nursing homes in central Missouri and the St. Louis area between August 15, 1995, and September 30, 1998. Economic analysis was restricted to 1033 episodes identified after March 31, 1997.


METHODS
We adjusted for the higher probability of initial hospitalization in sicker residents using measures of illness severity and a hospitalization propensity score. The propensity score was derived from a logistic regression model that included patient, physician, and facility variables. Estimated costs were attributed to initial treatment setting.


RESULTS
After controlling for the probability of hospitalization and illness severity, hospitalization was not a significant mortality predictor (odds ratio 0.89, 95% confidence interval 0.52-1.52). Mean daily cost was $138.24 for initial nursing home treatment and $419.75 for the hospital.


CONCLUSIONS
After controlling for illness severity and propensity for hospitalization, hospital treatment is not associated with either increased or decreased risk for mortality for nursing home residents with LRIs. For residents with low and medium mortality risk, nursing home treatment is likely to be safe and less costly.
Department of Family and Community Medicine, School of Medicine, University of Missouri-Columbia, Columbia, Missouri 65212, USA. kruser@health.missouri.edu
Robin L
RL
Kruse
David R
DR
Mehr
Keith E
KE
Boles
Judith R
JR
Lave
Ellen F
EF
Binder
Richard
R
Madsen
Ralph B
RB
D'Agostino
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D015577:Geriatric Assessment; D006707:Homes for the Aged / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D009735:Nursing Homes / Q000191:economics* / Q000706:statistics & numerical data; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D018410:Pneumonia, Bacterial / Q000191:economics* / Q000401:mortality* / Q000628:therapy; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors