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Health resource utilization and medical care cost of acute care elderly unit patients.

Jayadevappa R, Chhatre S, Weiner M, Raziano DB

Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104-2676, USA. jravi@mail.upenn.edu

OBJECTIVE: In this study we compared the readmissions, medical care cost, and health resource utilization (HRU) of acute care elderly (ACE) unit patients and usual medical care patients. METHODS: Retrospective case-control design was used. Patients admitted to ACE unit (n = 680) between 1999 and 2002 with primary admitting diagnosis of pneumonia, congestive heart failure, or urinary tract infection were randomly selected from the health-care system's administrative database. Equal number controls (n = 680) were selected from usual medical care services and were matched by DRG, age, ethnicity, and Charlson comorbidity score. Data on HRU, annual number of admissions before and after index admission, length of stay (LOS), and medical care cost were obtained. Bootstrap, t-test, and Wilcoxon test were used to compare cost, LOS, and number of readmissions between ACE and non-ACE unit. Multivariate log-linear and Poisson regressions were used to assess the impact of ACE unit on incremental cost and number of readmissions, respectively. RESULTS: Mean LOS was 1 day shorter for ACE unit (4.9 vs. 5.9 P = 0.01). Mean cost of ACE unit was 9.7% lower than that of non-ACE unit (Dollars 13,586 vs. Dollars 15,040, P = 0.012). Both groups had similar costs of pharmacy, diagnostic and therapeutic procedures. Multiple log-linear and Poisson regression models indicated that ACE unit patients had 21% lower cost and 11% lower annual readmissions. CONCLUSIONS: Our results confirm the hypotheses that ACE unit patients have lower medical care cost, shorter LOS, and fewer readmissions. Thus, ACE unit may be a beneficial model for improved inpatient care of elderly.

Published 12 May 2006 in Value Health, 9(3): 186-92.
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