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BMC Health Services Research
Published in: BMC Health Services Research 1/2015

Open Access 01-12-2015 | Research article

The cost of hospital-acquired complications for older people with and without dementia; a retrospective cohort study

Authors: Kasia Bail, John Goss, Brian Draper, Helen Berry, Rosemary Karmel, Diane Gibson

Published in: BMC Health Services Research | Issue 1/2015

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Abstract

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.
Literature
1.
Jackson T, Nghiem HS, Rowell D, Jorm C, Wakefield J. Marginal costs of hospital-acquired conditions: information for priority-setting for patient safety programmes and research. J Health Serv Res Policy. 2011;16(3):141–6.CrossRefPubMed
2.
Australian Institute of Health and Welfare. Australian hospital statistics 2011–12, vol. Health Services Series no. 50. Cat. no. HSE 134. Canberra: AIHW; 2013.
3.
Long SJ, Brown KF, Ames D, Vincent C. What is known about adverse events in older medical hospital inpatients? A systematic review of the literature. International J Qual Health Care. 2013;25(5):542–54.CrossRef
4.
Rowell D, Nghiem HS, Jorm C, Jackson TJ. How different are complications that affect the older adult inpatient? Qual Safety Health Care. 2010;19(6):e34.
5.
Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: Clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55(5):780–91.CrossRefPubMedPubMedCentral
6.
Pedersen SJ, Borgbjerg FA, Schousboe B, Pedersen BD, Jorgensen HL, Duus BR, et al. A comprehensive hip fracture program reduces complication rates and mortality. J Am Geriatr Soc. 2008;56(10):1831–8.CrossRefPubMed
7.
Mudge AM, Giebel AJ, Mgt MA, Cutler AJ. Exercising body and mind: An integrated approach to functional independence in hospitalized older people. J Am Geriatr Soc. 2008;56(4):630–5.CrossRefPubMed
8.
Needleman J, Buerhaus P, Potter V, Mattke S, Stewart M, Zelevinsky K. Nurse staffing and patient outcomes in hospitals. Nashville: Harvard School of Public Health; 2001.
9.
10.
Warshawsky N, Rayens MK, Stefaniak K, Rahman R. The effect of nurse manager turnover on patient fall and pressure ulcer rates. J Nurs Manag. 2013;21(5):725–32.CrossRefPubMed
11.
Australian Institute of Health and Welfare. Dementia care in hospitals: costs and strategies, vol. Cat. no. AGE 72. Canberra: AIHW; 2013.
12.
Bail K, Berry H, Grealish L, Draper B, Karmel R, Gibson D, et al. Potentially preventable complications of urinary tract infections, pressure areas, pneumonia, and delirium in hospitalised dementia patients: retrospective cohort study. BMJ Open. 2013;3(6):e002770.CrossRefPubMedPubMedCentral
13.
Australian Institute of Health and Welfare. The Hospital Dementia Services Project: a study description. In., vol. Cat. no. AGE 67. Canberra: AIHW; 2011.
14.
Australian Institute of Health and Welfare. Deriving key patient variables: a technical paper for the Hospital Dementia Services project. In. Canberra: AIHW; 2012.
15.
Draper B, Karmel R, Gibson D, Peut A, Anderson P. The Hospital Dementia Services Project: age differences in hospital stays for older people with and without dementia. Int Psychogeriatr. 2011;23(10):1649–58.CrossRefPubMed
16.
Duffield C, Roche M, O'Brien-Pallas L, Diers D, Aisbett C, King M, et al. Glueing it together: Nurses, their work environment and patient safety. Sydney: University of Technology; 2007.
17.
McCloskey BA, Diers DK. Effects of New Zealand's health reengineering on nursing and patient outcomes. Med Care. 2005;43(11):1140–6.CrossRefPubMed
18.
Australian Institute of Health and Welfare: Australian hospital statistics 2006–07, vol. Health Services Series no. 31. Cat. no. HSE 55. Canberra: AIHW 2008.
19.
Australian Government. National Hospital Cost Data Collection vol. Round 11 (2006–07). Department of Health and Ageing: Canberra; 2008.
20.
Australian Institute of Health and Welfare. Expenditures on health services for Aboriginal and Torres Strait Islander people 1998–99, vol. cat. no. IHW 7. Canberra: AIHW; 2001.
21.
Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol. 2004;57(12):1288–94.CrossRefPubMed
22.
Dall TM, Chen YJ, Seifert RF, Maddox PI, Hogan PF. The Economic Value of Professional Nursing. Med Care. 2009;47(1):97–104.CrossRefPubMed
23.
Sari ABA, Cracknell A, Sheldon TA. Incidence, preventability and consequences of adverse events in older people: results of a retrospective case-note review. Age Ageing. 2008;37(3):265–9.CrossRefPubMed
24.
Szlejf C, Farfel JM, Curiati JA, Couto Junior EDB, Jacob-Filho W, Azevedo RS. Medical adverse events in elderly hospitalized patients: A prospective study. Clinics. 2012;67(11):1247–52.CrossRefPubMedPubMedCentral
25.
Fox MT, Sidani S, Persaud M, Tregunno D, Maimets I, Brooks D, et al. Acute Care for Elders Components of Acute Geriatric Unit Care: Systematic Descriptive Review. J Am Geriatr Soc. 2013;61(6):939–46.CrossRefPubMed
26.
Duckett S, Jackson T: Do the elderly cost more? Casemix funding for elderly patients in acute inpatient settings., 2nd edn. Melbourne: Churchill Livingstone; 2005
27.
Heslop L. Status of costing hospital nursing work within Australian casemix activity-based funding policy. Int J Nurs Pract. 2012;18(1):2–6.CrossRefPubMed
28.
Streveler D, Hesp C. Promoting Interoperability of Health Insurance Information Systems through a Health Data Dictionary. Seattle: The Joint Learning Network for Universal Health Coverage; 2012.
Metadata
Title
The cost of hospital-acquired complications for older people with and without dementia; a retrospective cohort study
Authors
Kasia Bail
John Goss
Brian Draper
Helen Berry
Rosemary Karmel
Diane Gibson
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2015
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-015-0743-1

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