TY - JOUR
T1 - Predicting excess cost for older inpatients with clinical complexity
T2 - A retrospective cohort study examining cognition, comorbidities and complications
AU - Bail, Kasia
AU - Draper, Brian
AU - Berry, Helen
AU - Karmel, Rosemary
AU - Goss, John
N1 - Funding Information:
KB was sponsored by PhD Scholarship provided by Dementia Collaborative Research Centre. http://www.dementiaresearch.org.au. The PhD was nested in BD and RK’s project that was supported by the National Health and Medical Research Council (grant number 465701). https:// www.nhmrc.gov.au/. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Acknowledgments go to: statistical advisor Julio Romero; visualisation support Michael James Richardson; the Australian Institute of Health and Welfare for housing the data; and to Diane Gibson and Ann Peut for the initial idea, leadership, design and funding of the overarching Hospital Dementia Services Project this project was nested within.
Publisher Copyright:
© 2018 Bail et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2018/2/23
Y1 - 2018/2/23
N2 - BACKGROUND: Hospital-acquired complications increase length of stay and contribute to poorer patient outcomes. Older adults are known to be at risk for four key hospital-acquired complications (pressure injuries, pneumonia, urinary tract infections and delirium). These complications have been identified as sensitive to nursing characteristics such as staffing levels and level of education. The cost of these complications compared to the cost of admission severity, dementia, other comorbidities or age has not been established.METHOD: To investigate costs associated with nurse-sensitive hospital-acquired complications in an older patient population 157,178 overnight public hospital episodes for all patients over age 50 from one Australian state, 2006/07 were examined. A retrospective cohort study design with linear regression analysis provided modelling of length-of-stay costs. Explanatory variables included patient age, sex, comorbidities, admission severity, dementia status, surgical status and four complications. Extra costs were based on above-average length-of-stay for each patient's Diagnosis Related Group from hospital discharge data.RESULTS: For adults over 50 who have length of stay longer than average for their diagnostic condition, comorbid dementia predicts an extra cost of A$874, (US$1,247); any one of four key complications predicts A$812 (US$1,159); each increase in admission severity score predicts A$295 ($US421); each additional comorbidity predicts A$259 (US$370), and for each year of age above 50 predicts A$20 (US$29) (all estimates significant at p<0.0001).DISCUSSION: Hospital-acquired complications and dementia cost more than other kinds of inpatient complexity, but admission severity is a better predictor of excess cost. Because complications are potentially preventable and dementia care in hospitals can be improved, risk-reduction strategies for common complications, particularly for patients with dementia could be cost effective.CONCLUSIONS: Complications and dementia were found to cost more than other kinds of inpatient complexity.
AB - BACKGROUND: Hospital-acquired complications increase length of stay and contribute to poorer patient outcomes. Older adults are known to be at risk for four key hospital-acquired complications (pressure injuries, pneumonia, urinary tract infections and delirium). These complications have been identified as sensitive to nursing characteristics such as staffing levels and level of education. The cost of these complications compared to the cost of admission severity, dementia, other comorbidities or age has not been established.METHOD: To investigate costs associated with nurse-sensitive hospital-acquired complications in an older patient population 157,178 overnight public hospital episodes for all patients over age 50 from one Australian state, 2006/07 were examined. A retrospective cohort study design with linear regression analysis provided modelling of length-of-stay costs. Explanatory variables included patient age, sex, comorbidities, admission severity, dementia status, surgical status and four complications. Extra costs were based on above-average length-of-stay for each patient's Diagnosis Related Group from hospital discharge data.RESULTS: For adults over 50 who have length of stay longer than average for their diagnostic condition, comorbid dementia predicts an extra cost of A$874, (US$1,247); any one of four key complications predicts A$812 (US$1,159); each increase in admission severity score predicts A$295 ($US421); each additional comorbidity predicts A$259 (US$370), and for each year of age above 50 predicts A$20 (US$29) (all estimates significant at p<0.0001).DISCUSSION: Hospital-acquired complications and dementia cost more than other kinds of inpatient complexity, but admission severity is a better predictor of excess cost. Because complications are potentially preventable and dementia care in hospitals can be improved, risk-reduction strategies for common complications, particularly for patients with dementia could be cost effective.CONCLUSIONS: Complications and dementia were found to cost more than other kinds of inpatient complexity.
KW - Aged
KW - Aged, 80 and over
KW - Costs and Cost Analysis
KW - Delirium/diagnosis
KW - Dementia/diagnosis
KW - Female
KW - Humans
KW - Iatrogenic Disease/economics
KW - Length of Stay/economics
KW - Male
KW - Middle Aged
KW - Pneumonia/diagnosis
KW - Pressure Ulcer/diagnosis
KW - Retrospective Studies
KW - Urinary Tract Infections/diagnosis
UR - http://www.scopus.com/inward/record.url?scp=85042482105&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/8077a709-565f-3c2f-b9aa-b18b3dc31762/
U2 - 10.1371/journal.pone.0193319
DO - 10.1371/journal.pone.0193319
M3 - Article
C2 - 29474407
AN - SCOPUS:85042482105
SN - 1932-6203
VL - 13
SP - 1
EP - 16
JO - PLoS One
JF - PLoS One
IS - 2
M1 - e0193319
ER -