Shorter Hospital Stays for Older Patients with Pneumonia Lead to More Frequent Hospital Re-Admissions

Older patients hospitalized with pneumonia for an increasingly shorter length of time are more likely to be re-admitted or discharged to a nursing home, a study by a Yale researcher and collaborators shows.

“The length of stay is going down, and doctors are concerned,” said Thomas Meehan, M.D., assistant clinical professor of internal medicine at Yale School of Medicine and senior author of the study published in the Archives of Internal Medicine.”Our findings raise a note of caution that we canUt continue to decrease the length of stay and not have an eye as to the consequences.”

Pneumonia among older patients is responsible for more than 600,000 hospitalizations nationally and $9 billion in health care costs every year. About 10 percent of patients older than 64 who are hospitalized with pneumonia die while hospitalized. Many more die within a month of being discharged. Of those patients who do survive, about 12 percent require placement in a long-term care or rehabilitation facility.

Meehan and his co-researchers looked at patients over 65 who were discharged from Connecticut hospitals between Oct. 1, 1991 to Sept. 30, 1997, after being treated for pneumonia. In that six-year period, the average length of stay for these patients decreased from a mean of 11.9-11.4 days to 7.7-7.2 days.

The researchers looked at how the abbreviated hospital stays affected mortality rates for the patients while hospitalized; within 30 days after discharge; the risk of discharge to nursing homes, and the risk of hospital re-admission. They also assessed trends in hospital costs.

Meehan said they found, as expected, that the mortality rates during the patientsU hospital stays declined, because they were there for a much briefer period of time. However, the percentage of patients transferred to long term care facilities increased from 30.3 percent to 43.1 percent in the same period. The rate of mortality within 30 days after discharge increased from 6.9 percent to 9.3 percent. And re-admissions to the hospital for pneumonia within 30 days of discharge increased from 3 percent to 3.7 percent. The mean adjusted costs associated with hospitalization for pneumonia declined steadily over the five year period from $9,228 to $6,897.

“The next study, which we are doing right now, is looking at the fact that hospitals can control costs for older patients with pneumonia, but what are the adverse outcomes?” Meehan said. “What is the total cost to the healthcare system when you factor in rates of re-admission and transfer to long term care facilities?”

The principal investigator of the study was Mark Metersky, M.D., of the University of Connecticut School of Medicine. Co-authors included Michael Fine, M.D., of the University of Pittsburgh School of Medicine; and Janet Tate, MPH, and Marcia Petrillo, MA, of Qualidigm, a quality improvement organization based in Middletown. Metersky and Meehan also are affiliated with Qualidigm.