elderly pneumonia patients
Decreasing the length of time that older patients with pneumonia are hospitalized has increased the likelihood that those patients will be re-admitted or discharged to a nursing home, a study by a Yale researcher and collaborators shows.
"The length of stay is going down, and doctors are concerned," says Dr. Thomas Meehan, assistant clinical professor of internal medicine at the School of Medicine and senior author of the study published in the Archives of Internal Medicine. "Our findings raise a note of caution that we can't continue to decrease the length of stay and not have an eye as to the consequences."
Pneumonia among older patients is responsible for more than 600,000 hospitalizations nationally and $9 billion in health care costs every year. About 10% of patients older than 64 who are hospitalized with pneumonia die while hospitalized. Many more die within a month of being discharged. Of those patients who do survive, about 12% require placement in a long-term care or rehabilitation facility.
Meehan and his co-researchers looked at patients over 65 who were discharged from Connecticut hospitals between Oct. 1, 1991, and Sept. 30, 1997, after being treated for pneumonia. In that six-year period, the average length of stay for these patients decreased from a mean of 11.9-11.4 days to 7.7-7.2 days.
The researchers looked at how the abbreviated hospital stays affected mortality rates for the patients while hospitalized and within 30 days after discharge, the risk of discharge to nursing homes and the risk of hospital re-admission. They also assessed trends in hospital costs.
Meehan says they found, as expected, that the mortality rates during the patients' hospital stays declined, because they were there for a much briefer period of time. However, the percentage of patients transferred to long-term care facilities increased from 30.3% to 43.1% in the same period. The rate of mortality within 30 days after discharge increased from 6.9% to 9.3%. And re-admissions to the hospital for pneumonia within 30 days of discharge increased from 3% to 3.7%. The mean adjusted costs associated with hospitalization for pneumonia declined steadily over the five-year period from $9,228 to $6,897.
"The next study, which we are doing right now, is looking at the fact that hospitals can control costs for older patients with pneumonia, but what are the adverse outcomes?" Meehan says. "What is the total cost to the health care system when you factor in rates of re-admission and transfer to long-term care facilities?"
The principal investigator of the study was Dr. Mark Metersky of the University of Connecticut School of Medicine. Co-authors included Dr. Michael Fine of the University of Pittsburgh School of Medicine; and Janet Tate and Marcia Petrillo of Qualidigm, a quality-improvement organization based in Middletown, Connecticut. Metersky and Meehan also are affiliated with Qualidigm.
-- By Jacqueline Weaver
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