Document Detail

Do acute care for elders units increase hospital costs? A cost analysis using the hospital perspective.
MedLine Citation:
PMID:  9180668     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To compare the hospital costs of caring for medical patients on a special unit designed to help older people maintain or achieve independence in self-care activities with the costs of usual care. DESIGN: A randomized controlled study. PARTICIPANTS: A total of 650 medical patients (mean age 80 years, 67% women, 41% nonwhite) assigned randomly to either the intervention unit (n = 326) or usual care (n = 324). MEASURES: The hospital's resource-based cost of caring for patients was determined from the hospital's cost-accounting system. The cost of the intervention program was estimated and included in the intervention patients' total hospital cost. RESULTS: The development and maintenance costs of the intervention added $38.43 per bed day to the intervention patients' hospital costs. As a result, the cost per day to the hospital was slightly higher in the intervention patients than in the control patients ($876 vs $847, P = .076). However, the average length of stay was shorter for intervention patients (7.5 vs 8.4 days, P = .449). As a result, the hospital's total cost to care for intervention patients was not greater than caring for usual-care patients ($6608 in intervention patients vs $7240 in control patients, P = .926). Sensitivity analysis demonstrated that the cost of the intervention program would need to be 220% greater than estimated before intervention patients would be more expensive then control patients. There were no examined subgroups of patients in whom care on the intervention unit was significantly more expensive than care on the usual-care unit. Ninety-day nursing home use was lower in intervention than control patients (24.1% vs 32.3%, P = .034). Ninety-day readmission rates (36.7% vs 41.1%, P = .283) and caregiver strain scores (3.3 vs. 2.7, P = .280) were similar. CONCLUSION: Caring for patients on an intervention ward designed to improve functional outcomes in older patients was not more expensive to the hospital than caring for patients on a usual-care ward even though the intervention ward required a commitment of hospital resources.
K E Covinsky; J T King; L M Quinn; R Siddique; R Palmer; D M Kresevic; R H Fortinsky; J Kowal; C S Landefeld
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of the American Geriatrics Society     Volume:  45     ISSN:  0002-8614     ISO Abbreviation:  J Am Geriatr Soc     Publication Date:  1997 Jun 
Date Detail:
Created Date:  1997-06-24     Completed Date:  1997-06-24     Revised Date:  2008-03-10    
Medline Journal Info:
Nlm Unique ID:  7503062     Medline TA:  J Am Geriatr Soc     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  729-34     Citation Subset:  IM    
Division of General Internal Medicine and Health Care Research, University Hospitals of Cleveland, OH 44106, USA.
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MeSH Terms
Activities of Daily Living
Costs and Cost Analysis*
Hospital Costs*
Hospitalization / economics
Intensive Care Units / economics*
Random Allocation
Retrospective Studies
Grant Support
1K08AG00714-01/AG/NIA NIH HHS; AG-10418-04/AG/NIA NIH HHS

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