Does hospitalization impact survival after lower respiratory infection in nursing home residents?

BACKGROUND Lower respiratory infection (LRI) is the leading cause of hospitalization for nursing home residents, but hospitalization is costly and may cause complications. OBJECTIVE 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. DESIGN This was a prospective cohort study of nursing home residents with LRIs. SUBJECTS 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. MEASURES 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. RESULTS 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. CONCLUSIONS 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.