title: Trends in hospital utilization and outcome for patients with ALS: analysis of a large U.S. cohort.
abstract: OBJECTIVE
  To examine hospital mortality, utilization, and trends in care of patients with ALS in a large U.S. cohort.
  
  
  METHODS
  The authors performed a retrospective cohort comparison, using the Nationwide Inpatient Sample for 1988 to 2002. They identified admissions, comorbidities, and procedures using ICD-9 codes. Outcomes included reason for admission, cost (adjusted to 2002 dollars), length of stay, discharge disposition, and utilization of hospice care. Significance was set a priori at p < 0.001.
  
  
  RESULTS
  They identified 17,249 records. The significant findings were that common morbidities increased over time (pneumonia [38.1% to 47.3%], respiratory failure [26.9% to 35.5%], and nutritional deficiency [43.0% to 56.3%]); the median length of stay dropped from 6 to 4 days; mean hospital charges increased from 21,574 dollars to 24,314 dollars; the proportion of hospital deaths decreased over time (17.6% to 14.6%), whereas the proportion discharged to home health/hospice care (14.0% to 18.2%) and to long-term care facilities (13.2% to 27.9%) increased. The odds ratio (OR) of death was 5.03 (95% CI: 4.57 to 5.54) for those admitted with respiratory failure, 1.36 (1.24 to 1.50) for those with pneumonia, and 0.84 (0.77 to 0.92) for those with nutritional deficiency.
  
  
  CONCLUSIONS
  The high OR of death in patients admitted for pneumonia or respiratory failure is likely associated with more advanced disease, whereas the protective effect of admission for nutritional deficiency is consistent with the predominance of bulbar symptoms and admission earlier in the disease. The trends during the 15 years of this administrative data set were for increasing comorbidities and higher utilization of end-of-life care.
authors.affiliation: Department of Neurology, University of Kansas Medical Center, Mail Stop 2012, 3599 Rainbow Blvd., Kansas City, KS 66160, USA. rdubinsky@safetyresearch.com
authors.forename: Richard
authors.initials: R
authors.lastname: Dubinsky
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Chen
authors.forename: Sue-Min
authors.initials: SM
authors.lastname: Lai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000191:economics / Q000453:epidemiology* / Q000401:mortality* / Q000628:therapy*; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data / Q000639:trends; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010351:Patient Discharge / Q000191:economics / Q000706:statistics & numerical data; D012044:Regression Analysis; D012189:Retrospective Studies; D012306:Risk; D016019:Survival Analysis; D013997:Time Factors; D014481:United States / Q000453:epidemiology