TY - JOUR
T1 - The cost of hospital-acquired complications for older people with and without dementia; A retrospective cohort study Utilization, expenditure, economics and financing systems
AU - BAIL, Kasia
AU - Goss, John
AU - Draper, Brian
AU - BERRY, Helen
AU - Karmel, Rosemary
AU - GIBSON, Diane
N1 - Funding Information:
All authors have completed an ICMJE Form for Disclosure of Potential Conflicts of Interest. We acknowledge: grant funding from Dementia Collaborative Research Centres (DCRC) and National Health and Medical Research Council paid to authors’ institutions; and travel support for meetings paid by DCRC to authors’ institutions. Other disclosable relationships are: participation in a team and consultancy paid by Alzheimer’s Australia which uses some of the same database for some of the analysis; a NSW Government funded project related to the Hospital Dementia Study held by Alzheimer’s Australia NSW focusing on the experience of people with dementia discharged home from hospital relating to availability and suitability of community-based services; Pfizer paid travel expenses to present data from the Hospital Dementia Services study at an education meeting they sponsored (speaker’s fee was refused); and Department of Health and Ageing Australia paid for travel expenses to present data from the Hospital Dementia Services study at an educational meeting they sponsored. We have no other financial or non-financial competing interests to disclose.
Funding Information:
The Hospital Dementia Services Project was funded by the National Health and Medical Research Council (ID465701). Dementia Collaborative Research Centres provided a PhD scholarship to the corresponding author. This paper adheres to STROBE checklist for cohort studies, where appropriate.
Publisher Copyright:
© 2015 Bail et al.; licensee BioMed Central.
PY - 2015/3/8
Y1 - 2015/3/8
N2 - BACKGROUND: Increased length of stay and high rates of adverse clinical events in hospitalised patients with dementia is stimulating interest and debate about which costs may be associated and potentially avoided within this population.METHODS: A retrospective cohort study was designed to identify and compare estimated costs for older people in relation to hospital-acquired complications and dementia. Australia's most populous state provided a census sample of 426,276 discharged overnight public hospital episodes for patients aged 50+ in the 2006-07 financial year. Four common hospital-acquired complications (urinary tract infections, pressure areas, pneumonia, and delirium) were risk-adjusted at the episode level. Extra costs were attributed to patient length of stay above the average for each patient's Diagnosis Related Group, with separate identification of fixed and variable costs (all in Australian dollars).RESULTS: These four complications were found to be associated with 6.4% of the total estimated cost of hospital episodes for people over 50 (A$226million/A$3.5billion), and 24.7% of the estimated extra cost of above-average length of stay spent in hospital for older patients (A$226million/A$914million). Dementia patients were more likely than non-dementia patients to have complications (RR 2.5, p <0.001) and these complications comprised 22.0% of the extra costs (A$49million/A$226million), despite only accounting for 10.4% of the hospital episodes (44,488/426,276). For both dementia and non-dementia patients, the complications were associated with an eightfold increase in length of stay (813%, or 3.6 days/0.4 days) and doubled the increased estimated mean episode cost (199%, or A$16,403/A$8,240).CONCLUSION: Urinary tract infections, pressure areas, pneumonia and delirium are potentially preventable hospital-acquired complications. This study shows that they produce a burdensome financial cost and reveals that they are very important in understanding length of stay and costs in older and complex patients. Once a complication occurs, the cost is similar for people with and without dementia. However, they occur more often among dementia patients. Advances in models of care, nurse skill-mix and healthy work environments show promise in prevention of these complications for dementia and non-dementia patients.
AB - BACKGROUND: Increased length of stay and high rates of adverse clinical events in hospitalised patients with dementia is stimulating interest and debate about which costs may be associated and potentially avoided within this population.METHODS: A retrospective cohort study was designed to identify and compare estimated costs for older people in relation to hospital-acquired complications and dementia. Australia's most populous state provided a census sample of 426,276 discharged overnight public hospital episodes for patients aged 50+ in the 2006-07 financial year. Four common hospital-acquired complications (urinary tract infections, pressure areas, pneumonia, and delirium) were risk-adjusted at the episode level. Extra costs were attributed to patient length of stay above the average for each patient's Diagnosis Related Group, with separate identification of fixed and variable costs (all in Australian dollars).RESULTS: These four complications were found to be associated with 6.4% of the total estimated cost of hospital episodes for people over 50 (A$226million/A$3.5billion), and 24.7% of the estimated extra cost of above-average length of stay spent in hospital for older patients (A$226million/A$914million). Dementia patients were more likely than non-dementia patients to have complications (RR 2.5, p <0.001) and these complications comprised 22.0% of the extra costs (A$49million/A$226million), despite only accounting for 10.4% of the hospital episodes (44,488/426,276). For both dementia and non-dementia patients, the complications were associated with an eightfold increase in length of stay (813%, or 3.6 days/0.4 days) and doubled the increased estimated mean episode cost (199%, or A$16,403/A$8,240).CONCLUSION: Urinary tract infections, pressure areas, pneumonia and delirium are potentially preventable hospital-acquired complications. This study shows that they produce a burdensome financial cost and reveals that they are very important in understanding length of stay and costs in older and complex patients. Once a complication occurs, the cost is similar for people with and without dementia. However, they occur more often among dementia patients. Advances in models of care, nurse skill-mix and healthy work environments show promise in prevention of these complications for dementia and non-dementia patients.
KW - cost of hospital-acquired complications
KW - Delirium
KW - Pneumonia
KW - Humans
KW - Patient Discharge
KW - Male
KW - Hospitalization
KW - Length of Stay/economics
KW - Pressure Ulcer/economics
KW - Diagnosis-Related Groups/economics
KW - Aged, 80 and over
KW - Female
KW - Aged
KW - Retrospective Studies
KW - Australia
KW - Dementia
KW - Nosocomial infection
KW - Cost
KW - Nursing
KW - Adverse events
KW - Length of stay
UR - http://www.scopus.com/inward/record.url?scp=84926169387&partnerID=8YFLogxK
UR - http://www.mendeley.com/research/cost-hospitalacquired-complications-older-people-without-dementia-retrospective-cohort-study
U2 - 10.1186/s12913-015-0743-1
DO - 10.1186/s12913-015-0743-1
M3 - Article
C2 - 25890030
SN - 1472-6963
VL - 15
SP - 1
EP - 9
JO - BMC Health Services Research
JF - BMC Health Services Research
IS - 1
M1 - 91
ER -