Pressure ulcer status and post-discharge health care resource utilization among older adults with activity limitations

Abstract

In a prospective cohort study, we evaluated post-discharge health care utilization for patients 65 years of age or older whose activity was limited to bed or chair at the time of hospital admission. Post-discharge health care utilization was compared for those who did and those who did not develop a pressure ulcer during the hospital stay. Resource utilization was assessed using Medicare charges and payments reported for 1 year following the date of discharge. Pressure ulcer status during the index hospitalization was determined by study nurses. Sociodemographic data (age, gender, race, marital status) were recorded from the medical record. During the hospital stay, measures of severity of illness, occurrence of infections and other complications, service type (medical or surgical), ICU admission, and major and minor surgery were documented. At the time of discharge, the primary care nurse noted whether the patient was still confined to bed or chair and whether he or she was discharged to a nursing home. The study patients used substantial health care resources in the year following the index hospitalization, with mean Medicare charges and payments of $24,027 and $11,123, respectively. Eleven percent of the patients had developed pressure ulcers during the index hospitalization. These patients incurred Medicare payments during the 12-month post-discharge period that were, on average, $13 higher per day of follow-up than those of patients who had been at risk for, but did not develop, pressure ulcers during the index hospitalization (p = .02). Multivariate analyses suggested that activity limitation to bed or chair is an independent predictor of Medicare payments post-discharge. The in-hospital development of pressure ulcers is associated with higher daily Medicare payments in the year post-discharge, but this association does not remain statistically significant after adjusting for activity level at the time of hospital discharge.