感染对老年多病共存住院患者医疗费用和临床结局的影响。
Impact of infection on healthcare costs and clinical outcomes in elderly hospitalized patients with multimorbidity.
作者信息
Chen Xin, Geng Shasha, Zhu Yingqian, Li Qingqing, Li Yang, Yuan Huixiao, Jiang Hua
机构信息
Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
出版信息
Heliyon. 2024 May 19;10(10):e31560. doi: 10.1016/j.heliyon.2024.e31560. eCollection 2024 May 30.
BACKGROUND
Elderly patients with multimorbidity are at higher risk of greater healthcare costs and poor outcomes due to decreased physical function. The aim of this study was to investigate the impact of infection on healthcare costs and poor outcomes in elderly hospitalized patients with multimorbidity.
METHODS
We retrospectively enrolled 264 patients who met the inclusion criteria from the department of geriatrics of a large public hospital in Shanghai, China between January 2020 and December 2020. Patients were divided into two groups based on whether they had infection [infection present on admission (IPOA) or healthcare-associated infection(HAI)]. We recorded the basic information and follow-up information of all patients. The follow-up information included 30-day and 1-year all-cause readmission and mortality. Then we analyzed the association between infection and healthcare costs and clinical outcomes.
RESULTS
Among 264 subjects, 47.73 % of them achieved IPOA or HAI. The 30-day poor outcomes rate was 45.45 %, and the 1-year poor outcomes rate was 78.41 %. Compared with subjects without infection, the number of drugs and the disease burden were greater in subjects with infection(P < 0.001). Subjects with infection had longer length of hospital stay(P < 0.001) and had greater healthcare cost(P < 0.001). Moreover, subjects with infection had higher poor outcomes rates of 30-day and 1-year(P < 0.001). Infection could predict greater total cost [odds ratio (OR): 1.32, 95 % CI: 1.18,1.49,P < 0.001], nursing cost(OR: 11.45, 95 % CI: 3.49,37.63,P < 0.001), and medicine cost (OR: 2.37, 95 % CI: 1.70,3.31,P < 0.001). In addition, infection was also independently associated with the 30-day poor outcomes rate(OR:3.07, 95%CI: 1.80,5.24,P < 0.001), but we found no association between infection and 1-year poor outcomes rate(OR:1.43, 95 % CI:0.73,2.79,P = 0.300) after adjustment.
CONCLUSIONS
Infection was a risk factor for higher healthcare cost and 30-day poor outcome rate in elderly hospitalized patients with multimorbidity.
背景
患有多种疾病的老年患者因身体功能下降，面临更高的医疗成本风险和更差的预后。本研究旨在调查感染对患有多种疾病的老年住院患者医疗成本和不良预后的影响。
方法
我们回顾性纳入了2020年1月至2020年12月期间中国上海一家大型公立医院老年科符合纳入标准的264例患者。根据患者是否发生感染[入院时存在感染（IPOA）或医疗相关感染（HAI）]将其分为两组。我们记录了所有患者的基本信息和随访信息。随访信息包括30天和1年的全因再入院率和死亡率。然后我们分析了感染与医疗成本和临床结局之间的关联。
结果
在264名受试者中，47.73%的患者发生了IPOA或HAI。30天不良结局率为45.45%，1年不良结局率为78.41%。与未感染的受试者相比，感染受试者的用药数量和疾病负担更大（P<0.001）。感染受试者的住院时间更长（P<0.001），医疗成本更高（P<0.001）。此外，感染受试者的30天和1年不良结局率更高（P<0.001）。感染可预测更高的总成本[比值比（OR）：1.32，95%置信区间（CI）：1.18，1.49，P<0.001]、护理成本（OR：11.45，95%CI：3.49，37.63，P<0.001）和药品成本（OR：2.37，95%CI：1.70，3.31，P<0.001）。此外，感染还与30天不良结局率独立相关（OR：3.07，95%CI：1.80，5.24，P<0.001），但调整后我们发现感染与1年不良结局率之间无关联（OR：1.43，95%CI：0.73，2.79，P=0.300）。
结论
感染是患有多种疾病的老年住院患者医疗成本增加和30天不良结局率升高的危险因素。
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