Neglect: Nursing home treatment for lower respiratory infection is safe and less costly than hospitalization for some residents

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From 21 to 30 percent of nursing home residents are hospitalized for lower respiratory infections (LRIs), primarily pneumonia and bronchitis. Yet, nursing home residents at low and medium risk of dying from an LRI can be treated at the nursing home safely and less expensively than in the hospital, according to a study supported in part by the Agency for Healthcare Research and Quality (HS08551).

David R. Mehr, M.D., of the University of Missouri-Columbia, and his colleagues prospectively studied residents of 36 Missouri nursing homes who had an LRI between 1995 and 1998. They compared the mortality and cost of over 1,000 LRI episodes initially treated in the hospital (those hospitalized within 24 hours of evaluation who had received no antibiotics in the nursing home in the 2 days before evaluation) with those treated in the nursing home.

After controlling for residents' probability of hospitalization and illness severity, residents who were treated at the nursing home were not significantly more or less likely to die than those who were hospitalized for LRI (odds ratio 0.89 and 1.0 for 30-day mortality, depending on method of analysis; 1 is equal odds). In addition, nursing home treatment was less costly, with a mean daily cost over 30 days of $138.24 for initial nursing home treatment compared with $419.75 for hospital treatment.

Thus, for nursing home residents at low or medium risk of death from LRI, nursing home treatment is likely to be safe and less costly than hospitalization, conclude the researchers. Their findings revealed an overall LRI mortality rate of 14.7 percent, with 24.7 percent mortality for episodes initially treated in the hospital and 13.1 percent for episodes initially treated in the nursing home. Of residents who died, 75.4 percent were initially treated in the hospital. The researchers note, however, that aggressive therapy may not be appropriate for some frail nursing home residents, and hospitalization may lead to complications such as delirium and pressure sores.

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