title: Consequences of preventing delirium in hospitalized older adults on nursing home costs.
abstract: 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.
authors.affiliation: Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. douglas.leslie@yale.edu
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Leslie
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.forename: Sidney T
authors.initials: ST
authors.lastname: Bogardus
authors.forename: Theodore R
authors.initials: TR
authors.lastname: Holford
authors.forename: Linda S
authors.initials: LS
authors.lastname: Leo-Summers
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Inouye
mesh_terms: 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