Kruse Robin L, Boles Keith E, Mehr David R, Spalding Diane, Lave Judith R
Department of Family and Community Medicine, University of Missouri-Columbia, MO, USA.
J Am Med Dir Assoc. 2003 Mar-Apr;4(2):81-9. doi: 10.1097/01.JAM.0000052520.62718.13.
To determine the costs of treating pneumonia in the nursing home setting and explore what factors are most responsible for that cost with a view to reducing cost.
Prospective cohort study.
Thirty-six Missouri nursing homes participating in the study from April 1997 through September 1998.
Nursing home residents with pneumonia who were not hospitalized (n = 502). We included residents evaluated in the emergency department (ED) and returned to the nursing home without admission.
Residents were evaluated by project nurses. Examination findings, diagnostic testing, and treatment information for 30 days following evaluation were abstracted from medical records. Bills were obtained for individuals evaluated in the ED.
There was significant variation in the cost of treating pneumonia in nursing homes. Episode costs were higher for residents seen in the ED of a hospital, residents with decubitus ulcers, black residents, and residents in larger facilities. Although total episode costs were related to illness severity, most of the variation in cost is not explained by resident or illness characteristics. The average cost for treating an episode of pneumonia in the nursing home, over and above usual care, was $458.
There is wide variation in treatment for residents with similar clinical presentations. For residents at low risk of mortality, using less expensive antibiotics and reducing ED evaluation could result in cost reductions, although the effect on outcomes is unknown.
确定在疗养院环境中治疗肺炎的成本，并探讨哪些因素对该成本影响最大，以期降低成本。
前瞻性队列研究。
1997年4月至1998年9月期间参与研究的36家密苏里州疗养院。
未住院的患有肺炎的疗养院居民（n = 502）。我们纳入了在急诊科接受评估后返回疗养院而未住院的居民。
由项目护士对居民进行评估。从病历中提取评估后30天的检查结果、诊断测试和治疗信息。获取在急诊科接受评估的个人的账单。
疗养院中治疗肺炎的成本存在显著差异。在医院急诊科就诊的居民、患有褥疮的居民、黑人居民以及大型疗养院的居民的单次治疗成本更高。尽管单次治疗总成本与疾病严重程度相关，但成本的大部分差异无法用居民或疾病特征来解释。在疗养院中，除常规护理外，治疗一次肺炎的平均成本为458美元。
具有相似临床表现的居民的治疗存在很大差异。对于死亡风险较低的居民，使用成本较低的抗生素并减少急诊科评估可能会降低成本，尽管对治疗结果的影响尚不清楚。
