TY - JOUR
T1 - Determinants of Post-acute Care Costs in Acutely Hospitalized Older Adults: The Hospital-ADL Study
T2 - The Hospital-ADL Study
AU - Hospital-ADL study group
AU - Ribbink, M.E.
AU - van Seben, R.
AU - Reichardt, L.A.
AU - Aarden, J.J.
AU - van der Schaaf, M.
AU - Engelbert, R.H.H.
AU - Twisk, J.W.R.
AU - Bosch, J.A.
AU - MacNeil Vroomen, J.L.
AU - Buurman, B.M.
AU - Kuper, Ingeborg
AU - de Jonghe, Annemarieke
AU - Leguit-Elberse, Maike
AU - Kamper, Ad
AU - Posthuma, Nynke
AU - Brendel, Nienke
AU - Wold, Johan
AU - Marte E., RIbbink
AU - Jos A., Bosch
AU - Post-Huma, Nynke
N1 - Copyright © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
PY - 2019/10/1
Y1 - 2019/10/1
N2 - OBJECTIVES: After hospitalization, many older adults need post-acute care, including rehabilitation or home care. However, post-acute care expenses can be as high as the costs for the initial hospitalization. Detailed information on monthly post-acute health care expenditures and the characteristics of patients that make up for a large share of these expenditures is scarce. We aimed to calculate costs in acutely hospitalized older patients and identify patient characteristics that are associated with high post-acute care costs.DESIGN: Prospective multicenter cohort study (between October 2015 and June 2017).SETTING AND PARTICIPANTS: 401 acutely hospitalized older persons from internal medicine, cardiology, and geriatric wards.MEASUREMENTS: Our primary outcome was mean post-acute care costs within 90 days postdischarge. Post-acute care costs included costs for unplanned readmissions, home care, nursing home care, general practice, and rehabilitation care. Three costs categories were defined: low [0-50th percentile (p0-50)], moderate (p50-75), and high (p75-100). Multinomial logistic regression analyses were conducted to assess the associations between costs and frailty, functional impairment, health-related quality of life, cognitive impairment, and depressive symptoms.RESULTS: Costs were distributed unevenly in the population, with the top 10.0% (n = 40) accounting for 52.1% of total post-acute care costs. Mean post-acute care costs were €4035 [standard deviation (SD) 4346] or $4560 (SD 4911). Frailty [odds ratio (OR) 3.44, 95% confidence interval (CI) 1.78-6.63], functional impairment (OR 1.80, 95% CI 1.03-3.16), and poor health-related quality of life (OR 1.89, 95% CI 1.09-3.28) at admission were associated with classification in the high-cost group, compared with the low-cost group.CONCLUSIONS/IMPLICATIONS: Post-acute care costs are substantial in a small portion of hospitalized older adults. Frailty, functional impairment, and poor health-related quality of life are associated with higher post-acute care costs and may be used as an indicator of such costs in practice.
AB - OBJECTIVES: After hospitalization, many older adults need post-acute care, including rehabilitation or home care. However, post-acute care expenses can be as high as the costs for the initial hospitalization. Detailed information on monthly post-acute health care expenditures and the characteristics of patients that make up for a large share of these expenditures is scarce. We aimed to calculate costs in acutely hospitalized older patients and identify patient characteristics that are associated with high post-acute care costs.DESIGN: Prospective multicenter cohort study (between October 2015 and June 2017).SETTING AND PARTICIPANTS: 401 acutely hospitalized older persons from internal medicine, cardiology, and geriatric wards.MEASUREMENTS: Our primary outcome was mean post-acute care costs within 90 days postdischarge. Post-acute care costs included costs for unplanned readmissions, home care, nursing home care, general practice, and rehabilitation care. Three costs categories were defined: low [0-50th percentile (p0-50)], moderate (p50-75), and high (p75-100). Multinomial logistic regression analyses were conducted to assess the associations between costs and frailty, functional impairment, health-related quality of life, cognitive impairment, and depressive symptoms.RESULTS: Costs were distributed unevenly in the population, with the top 10.0% (n = 40) accounting for 52.1% of total post-acute care costs. Mean post-acute care costs were €4035 [standard deviation (SD) 4346] or $4560 (SD 4911). Frailty [odds ratio (OR) 3.44, 95% confidence interval (CI) 1.78-6.63], functional impairment (OR 1.80, 95% CI 1.03-3.16), and poor health-related quality of life (OR 1.89, 95% CI 1.09-3.28) at admission were associated with classification in the high-cost group, compared with the low-cost group.CONCLUSIONS/IMPLICATIONS: Post-acute care costs are substantial in a small portion of hospitalized older adults. Frailty, functional impairment, and poor health-related quality of life are associated with higher post-acute care costs and may be used as an indicator of such costs in practice.
KW - Frail older adults
KW - health care expenditures
KW - hospitalization
KW - resource utilization
KW - subacute care
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85065022605&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/31056452
UR - http://www.scopus.com/inward/record.url?scp=85065022605&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jamda.2019.03.013
DO - https://doi.org/10.1016/j.jamda.2019.03.013
M3 - Article
C2 - 31056452
SN - 1525-8610
VL - 20
SP - 1300-1306.e1
JO - American Medical Directors Association. Journal
JF - American Medical Directors Association. Journal
IS - 10
ER -