Consequences of preventing delirium in hospitalized older adults on nursing home costs
Consequences of preventing delirium in hospitalized older adults on nursing home costs
复制标题
DOI：
10.1111/j.1532-5415.2005.53156.x
复制
发表时间：
2005-03-01
影响因子：
6.3
通讯作者：
Inouye, SK
中科院分区：
文献类型：
--
作者：
Leslie, DL;Zhang, Y;Inouye, SK
目的：为了确定长期护理之家（NH）护理的费用，谁收到了多组分有针对性的干预（MTI），以防止谵妄，而住院的患者是低于那些谁没有收到的intervention.Design：纵向随访从一个随机试验。设置：出院后设置：社区为基础的护理和NH。参与者：801住院患者年龄在70岁及以上。测量：患者出院后随访1年，并构建NH服务使用和成本的措施。使用两部分回归模型估计长期NH总成本，并在干预组和对照组之间进行比较。在干预组的400名患者和匹配的对照组的401名患者中，分别有153名（38%）和148名（37%）在一年中入住NH，分别有54名（13%）和51名（13%），是长期的NH患者。MTI对接受长期NH护理的可能性没有影响，但在接受长期NH护理的患者中，MTI组的总成本显着降低，住院时间缩短，每个生存日的成本降低。MTI组和对照组的调整后总成本分别为50，881美元和60，327美元，节省了15.7%（P= 0.01）。结论：预防谵妄的积极方法与长期NH成本降低15.7%相关。接受长期NH服务的患者住院时间较短是这些节省的主要来源。
OBJECTIVES: To determine whether costs of long-term nursing home (NH) care for patients who received a multicomponent targeted intervention (MTI) to prevent delirium while hospitalized were less than for those who did not receive the intervention.DESIGN: Longitudinal follow-up from a randomized trial.SETTING: Posthospital discharge settings: community-based care and NHs.PARTICIPANTS: Eight hundred one hospitalized patients aged 70 and older.MEASUREMENTS: Patients were followed for 1 year after discharge, and measures of NH service use and costs were constructed. Total long-term NH costs were estimated using a two-part regression model and compared across intervention and control groups.RESULTS: Of the 400 patients in the intervention group and 401 patients in the matched control group, 153 (38%) and 148 (37%), respectively, were admitted to a NH during the year, and 54 (13%) and 51 (13%), respectively, were long-term NH patients. The MTI had no effect on the likelihood of receiving long-term NH care, but of patients receiving long-term NH care, those in the MTI group had significantly lower total costs, shorter length of stay and lower cost per survival day. Adjusted total costs were $50,881 per long-term NH patient in the MTI group and $60,327 in the control group, a savings of 15.7% (P=.01).CONCLUSION: Active methods to prevent delirium are associated with a 15.7% decrease in long-term NH costs. Shorter length of stay of patients receiving long-term NH services was the primary source of these savings.