Cost of hospital care for older adults with heart failure: medical, pharmaceutical, and nursing costs.
OBJECTIVE
To determine the impact of patient characteristics, clinical conditions, hospital unit characteristics, and health care interventions on hospital cost of patients with heart failure.


METHODS
Data for this study were part of a larger study that used electronic clinical data repositories from an 843-bed, academic medical center in the Midwest.


METHODS
This retrospective, exploratory study used existing administrative and clinical data from 1,435 hospitalizations of 1,075 patients 60 years of age or older. A cost model was tested using generalized estimating equations (GEE) analysis.


METHODS
Electronic databases used in this study were the medical record abstract, the financial data repository, the pharmacy repository; and the Nursing Information System repository. Data repositories were merged at the patient level into a relational database and housed on an SQL server.


RESULTS
The model accounted for 88 percent of the variability in hospital costs for heart failure patients 60 years of age and older. The majority of variables that were associated with hospital cost were provider interventions. Each medical procedure increased cost by $623, each unique medication increased cost by $179, and the addition of each nursing intervention increased cost by $289. One medication and several nursing interventions were associated with lower cost. Nurse staffing below the average and residing on 2-4 units increased hospital cost.


CONCLUSIONS
The model and data analysis techniques used here provide an innovative and useful methodology to describe and quantify significant health care processes and their impact on cost per hospitalization. The findings indicate the importance of conducting research using existing clinical data in health care.
Titler
Marita G
MG
Research, Quality and Outcomes Management, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, RM T100 GH, Iowa City, IA, USA.
Jensen
Gwenneth A
GA
Dochterman
Joanne McCloskey
JM
Xie
Xian-Jin
XJ
Kanak
Mary
M
Reed
David
D
Shever
Leah L
LL
D000046:Academic Medical Centers; D000368:Aged; D015897:Comorbidity; D003365:Costs and Cost Analysis; D005260:Female; D006333:Heart Failure / Q000191:economics* / Q000628:therapy*; D006746:Hospital Bed Capacity, 500 and over; D017721:Hospital Costs / Q000145:classification / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000191:economics* / Q000458:organization & administration; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000191:economics* / Q000458:organization & administration; D010607:Pharmacy Service, Hospital / Q000191:economics* / Q000458:organization & administration; D012189:Retrospective Studies; D012720:Severity of Illness Index