Dependent older patients may cost hospitals more

proprietary cost accounting system that assigns direct and indirect costs to individual patients based on their use of hospital resources.

Chuang's team examined records for 1,612 patients aged 70 or older and compared each patient's assigned costs with an evaluation of his or her functional status upon admission. Evaluations consisted of asking patients whether they could perform certain routine activities without requiring assistance two weeks before admission to the hospital and at the time of admission to the hospital. Patients were rated as dependent if they needed help with one or more of the following tasks: bathing, dressing, eating, toileting, or transferring from a bed to a chair.

The analysis showed that the patients' mean age was 81, two out of three were women, and 12 percent were admitted to the hospital from a nursing home. Sixty-four percent were dependent in one or more of the five tasks on admission to the hospital. On average, dependent patients were three years older than independent patients. Nearly all patients admitted from nursing homes were dependent.

Chuang and his team determined that, overall, patients who were dependent in one or more daily activities incurred costs of $5,300 during their hospitalizations, while independent patients incurred $4,060 in costs: a difference of 31 percent. When the team adjusted these figures to take into account the difference in profiles of dependent and independent patients, they still found that dependent patients cost the hospital 23 percent more than independent patients.

The team found that most of the differences in cost could be attributed to the fact that dependent patients had longer average stays than independent patients: 7.7 days versus 5.7 days. Yet even after accounting for length of stay, dependent patients cost the hospital 6 percent more than independent patients.

"There were big differences here," Chuang says. "And the costs were not made up by Med

Contact: Liese Greensfelder
University of California - San Francisco

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