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. 2018 Feb 23;13(2):e0193319.
doi: 10.1371/journal.pone.0193319. eCollection 2018.

Predicting excess cost for older inpatients with clinical complexity: A retrospective cohort study examining cognition, comorbidities and complications

Kasia Bail  1 , Brian Draper  2 , Helen Berry  3 , Rosemary Karmel  4 , John Goss  1
Affiliations

Predicting excess cost for older inpatients with clinical complexity: A retrospective cohort study examining cognition, comorbidities and complications

Kasia Bail et al. PLoS One. .

Abstract

Background: Hospital-acquired complications increase length of stay and contribute to poorer patient outcomes. Older adults are known to be at risk for four key hospital-acquired complications (pressure injuries, pneumonia, urinary tract infections and delirium). These complications have been identified as sensitive to nursing characteristics such as staffing levels and level of education. The cost of these complications compared to the cost of admission severity, dementia, other comorbidities or age has not been established.

Method: To investigate costs associated with nurse-sensitive hospital-acquired complications in an older patient population 157,178 overnight public hospital episodes for all patients over age 50 from one Australian state, 2006/07 were examined. A retrospective cohort study design with linear regression analysis provided modelling of length-of-stay costs. Explanatory variables included patient age, sex, comorbidities, admission severity, dementia status, surgical status and four complications. Extra costs were based on above-average length-of-stay for each patient's Diagnosis Related Group from hospital discharge data.

Results: For adults over 50 who have length of stay longer than average for their diagnostic condition, comorbid dementia predicts an extra cost of A$874, (US$1,247); any one of four key complications predicts A$812 (US$1,159); each increase in admission severity score predicts A$295 ($US421); each additional comorbidity predicts A$259 (US$370), and for each year of age above 50 predicts A$20 (US$29) (all estimates significant at p<0.0001).

Discussion: Hospital-acquired complications and dementia cost more than other kinds of inpatient complexity, but admission severity is a better predictor of excess cost. Because complications are potentially preventable and dementia care in hospitals can be improved, risk-reduction strategies for common complications, particularly for patients with dementia could be cost effective.

Conclusions: Complications and dementia were found to cost more than other kinds of inpatient complexity.

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Conflict of interest statement

Competing Interests: All authors have completed the Unified Competing Interests form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author). I have read the journal's policy and the authors of this manuscript have the following competing interests: that support has been received by the employing organisations from Alzheimer’s Australia in regard to commissioned work using data collected in the course of the Hospital Dementia Services Project. Brian Draper declares Pfizer paid travel expenses to present data from the HDS project at an educational meeting the company sponsored, but refused a speakers fee. Department of Health and Ageing, Australia, paid travel expenses to Brian Draper to present data from the HDS project at an educational meeting they sponsored.

Figures

Fig 1
Fig 1. Effect of coefficient.
See this image and copyright information in PMC

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