Consequences of preventing delirium in hospitalized older adults on nursing home costs.
OBJECTIVE
To determine whether costs of long-term nursing home (NH) care for patients who received a multicomponent targeted intervention (MTI) to prevent delirium while hospitalized were less than for those who did not receive the intervention.


METHODS
Longitudinal follow-up from a randomized trial.


METHODS
Posthospital discharge settings: community-based care and NHs.


METHODS
Eight hundred one hospitalized patients aged 70 and older.


METHODS
Patients were followed for 1 year after discharge, and measures of NH service use and costs were constructed. Total long-term NH costs were estimated using a two-part regression model and compared across intervention and control groups.


RESULTS
Of the 400 patients in the intervention group and 401 patients in the matched control group, 153 (38%) and 148 (37%), respectively, were admitted to a NH during the year, and 54 (13%) and 51 (13%), respectively, were long-term NH patients. The MTI had no effect on the likelihood of receiving long-term NH care, but of patients receiving long-term NH care, those in the MTI group had significantly lower total costs, shorter length of stay and lower cost per survival day. Adjusted total costs were $50,881 per long-term NH patient in the MTI group and $60,327 in the control group, a savings of 15.7% (P=.01).


CONCLUSIONS
Active methods to prevent delirium are associated with a 15.7% decrease in long-term NH costs. Shorter length of stay of patients receiving long-term NH services was the primary source of these savings.
Leslie
Douglas L
DL
Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. douglas.leslie@yale.edu
Zhang
Ying
Y
Bogardus
Sidney T
ST
Holford
Theodore R
TR
Leo-Summers
Linda S
LS
Inouye
Sharon K
SK
D000203:Activities of Daily Living; D000368:Aged; D016022:Case-Control Studies; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data*; D003704:Dementia / Q000191:economics / Q000517:prevention & control*; D005260:Female; D005853:Geriatrics / Q000191:economics*; D006760:Hospitalization; D006801:Humans; D008134:Long-Term Care / Q000191:economics*; D008137:Longitudinal Studies; D008297:Male; D009735:Nursing Homes / Q000191:economics*; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis