Journal of the American Medical Directors Association
Original StudiesThe Cost of Treating Pneumonia in the Nursing Home Setting
Section snippets
Subjects
Subjects of this cost study were identified from residents of 36 central Missouri and St. Louis area nursing homes (approximately 4000 beds) who developed symptoms compatible with an LRI between April 1, 1997 and September 30, 1998. The patients were part of a larger study focusing on outcomes of LRI (predominantly pneumonia) in nursing home residents (the Missouri LRI Study). Details concerning resident identification and evaluations have been presented elsewhere. 13, 14 Briefly, project
Subjects
From April 1997 through September 1998, we evaluated 1341 residents for 2010 potential episodes of LRI (Figure 1). Of these, 1119 episodes met the LRI study definition. X-ray reports indicated possible, probable, or definite pneumonia (hereafter pneumonia) in 760 episodes. The sample for this study comprised the 502 pneumonia episodes (66%) involving residents who were not admitted to the hospital during the 30 days following evaluation. These episodes represent 444 individuals. Most
Discussion
The mean incremental cost for treating an episode of pneumonia in the nursing home was $427; if ED costs are included, mean episode cost increased to $458. In a study of acute medical conditions in incontinent residents of three California nursing homes, Alessi et al. 29 calculated mean nursing home costs for pneumonia treatment were $575. Their estimates included treatments and services not included in our analysis, such as all routine and as needed medications, nurse-administered treatments,
Conclusion
There is a wide range of costs of treating pneumonia in residents of nursing homes. Most of that variation is unrelated to illness severity. Decreasing the variability in treatment processes could likely reduce the cost of treating pneumonia in nursing home residents. In particular, sending only the sickest residents to the ED for evaluation and avoiding use of the most expensive antibiotics are two of the most likely ways of reducing cost. Any plans for reducing cost must also consider the
Acknowledgments
We gratefully acknowledge the support of the many individuals who made this project possible. We received the support and cooperation of the many attending physicians and the administration and staff of the 36 nursing homes that contributed subjects to this study. Karen Davenport provided crucial administrative support. Dr. Clive Levine, our project radiologist, reread over 200 X-rays to help us make final determination on pneumonia status. Dr. Richard Madsen helped with the statistical
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Cited by (16)
Additional Cost Because of Pneumonia in Nursing Home Residents: Results From the Incidence of Pneumonia and Related Consequences in Nursing Home Resident Study
2017, Journal of the American Medical Directors AssociationCitation Excerpt :The results of this study highlight the potential economic savings that could be achieved if pneumonia could be prevented in NHs. As we hypothesized, healthcare cost because of pneumonia in NHs is above the cost estimated by Kruse et al,7 which was $458 for 1 episode of pneumonia. This cost did not include hospitalizations costs, which have the greatest impact on additional cost.
Nursing Home-Associated Pneumonia
2007, Clinics in Geriatric MedicineCitation Excerpt :Other factors may influence a decision to hospitalize residents who have pneumonia. Because nursing homes are not responsible for the cost of hospital care and may not be reimbursed fully for caring for residents who have pneumonia in a facility, the facility has a financial incentive to transfer residents to hospitals for treatment [29]. Lack of bedside assessment by a physician also may be a factor influencing a hospitalization decision [30].
Should i hospitalize my resident with nursing home-acquired pneumonia?
2006, Journal of the American Medical Directors AssociationShould I hospitalize my resident with nursing home-acquired pneumonia?
2005, Journal of the American Medical Directors Association
Supported by grant HS08551 from the Agency for Healthcare Research and Quality and Dr. Mehr's Robert Wood Johnson Foundation Generalist Physician Faculty Scholars award. Dr. Kruse was supported by Institutional National Research Service Award number PE10038 from the Health Resources and Services Administration.