Kruse Robin L, Mehr David R, Boles Keith E, Lave Judith R, Binder Ellen F, Madsen Richard, D'Agostino Ralph B
Department of Family and Community Medicine, School of Medicine, University of Missouri-Columbia, Columbia, Missouri 65212, USA.
Med Care. 2004 Sep;42(9):860-70. doi: 10.1097/01.mlr.0000135828.95415.b1.
Lower respiratory infection (LRI) is the leading cause of hospitalization for nursing home residents, but hospitalization is costly and may cause complications.
We sought to compare mortality and cost between episodes of LRI initially treated in the hospital versus the nursing home after controlling for illness severity and the probability of hospitalization.
This was a prospective cohort study of nursing home residents with LRIs.
We identified 1406 episodes of LRI in 36 nursing homes in central Missouri and the St. Louis area between August 15, 1995, and September 30, 1998. Economic analysis was restricted to 1033 episodes identified after March 31, 1997.
We adjusted for the higher probability of initial hospitalization in sicker residents using measures of illness severity and a hospitalization propensity score. The propensity score was derived from a logistic regression model that included patient, physician, and facility variables. Estimated costs were attributed to initial treatment setting.
After controlling for the probability of hospitalization and illness severity, hospitalization was not a significant mortality predictor (odds ratio 0.89, 95% confidence interval 0.52-1.52). Mean daily cost was $138.24 for initial nursing home treatment and $419.75 for the hospital.
After controlling for illness severity and propensity for hospitalization, hospital treatment is not associated with either increased or decreased risk for mortality for nursing home residents with LRIs. For residents with low and medium mortality risk, nursing home treatment is likely to be safe and less costly.
下呼吸道感染（LRI）是疗养院居民住院的主要原因，但住院费用高昂且可能引发并发症。
在控制疾病严重程度和住院可能性之后，我们试图比较最初在医院与疗养院接受治疗的LRI发作之间的死亡率和成本。
这是一项针对患有LRI的疗养院居民的前瞻性队列研究。
我们在1995年8月15日至1998年9月30日期间，在密苏里州中部和圣路易斯地区的36家疗养院中确定了1406例LRI发作。经济分析仅限于1997年3月31日之后确定的1033例发作。
我们使用疾病严重程度指标和住院倾向评分，对病情较重的居民最初住院可能性较高的情况进行了调整。倾向评分来自一个逻辑回归模型，该模型包括患者、医生和机构变量。估计成本归因于初始治疗环境。
在控制住院可能性和疾病严重程度之后，住院并不是一个显著的死亡率预测因素（比值比0.89，95%置信区间0.52 - 1.52）。疗养院初始治疗的平均每日成本为138.24美元，医院为419.75美元。
在控制疾病严重程度和住院倾向之后，对于患有LRI的疗养院居民，医院治疗与死亡率增加或降低均无关。对于低和中等死亡风险的居民，疗养院治疗可能是安全且成本较低的。
