Abstract:
OBJECTIVES:To determine whether hospital costs are higher in patients with lower functional status at admission, defined as dependence in one or more activities of daily living (ADLs), after adjustment for Medicare Diagnosis-Related Group (DRG) payments. DESIGN:Prospective study. SETTING:General medical service at a teaching hospital. PARTICIPANTS:One thousand six hundred twelve patients aged 70 and older. MEASUREMENTS:The hospital cost of care for each patient was determined using a cost management information system, which allocates all hospital costs to individual patients. RESULTS:Hospital costs were higher in patients dependent in ADLs on admission than in patients independent in ADLs on admission ($5,300 vs $4,060, P<.01). Mean hospital costs remained higher in ADL-dependent patients than in ADL-independent patients in an analysis that adjusted for DRG weight ($5,240 vs $4,140, P<.01), and in multivariate analyses adjusting for age, race, sex, Charlson comorbidity score, acute physiology and chronic health evaluation score, and admission from a nursing home as well as for DRG weight ($5,200 vs $4,220, P<.01). This difference represents a 23% (95% confidence interval=15-32%) higher cost to take care of older dependent patients. CONCLUSION:Hospital cost is higher in patients with worse ADL function, even after adjusting for DRG payments. If this finding is true in other hospitals, DRG-based payments provide hospitals a financial incentive to avoid patients dependent in ADLs and disadvantage hospitals with more patients dependent in ADLs.
journal_name
J Am Geriatr Socjournal_title
Journal of the American Geriatrics Societyauthors
Chuang KH,Covinsky KE,Sands LP,Fortinsky RH,Palmer RM,Landefeld CSdoi
10.1046/j.1532-5415.2003.51556.xsubject
Has Abstractpub_date
2003-12-01 00:00:00pages
1729-34issue
12eissn
0002-8614issn
1532-5415pii
51556journal_volume
51pub_type
杂志文章abstract:OBJECTIVES:To determine the clinical presentation, findings, and outcomes of older adults (> 60) with severe acute respiratory syndrome (SARS) and compare these with a control group of younger patients (< or or =60). DESIGN:Retrospective cohort study. SETTING:A community-based, acute hospital in Hong Kong. PARTICIPA...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2004.52362.x
更新日期:2004-08-01 00:00:00
abstract:OBJECTIVES:To quantify the relationship between indwelling devices (urinary catheters, feeding tubes, and peripherally inserted central catheters) and carriage of antimicrobial-resistant pathogens in nursing home residents. DESIGN:Cross-sectional. SETTING:Community nursing home in Southeast Michigan. PARTICIPANTS:Re...
journal_title:Journal of the American Geriatrics Society
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更新日期:2007-12-01 00:00:00
abstract::The Schulich School of Medicine, University of Western Ontario, Canada, has created a mandatory clerkship in Elder Care that consists of small group seminars, clinical experiences, and an Elder Care manual. This article describes the use of a paper-based log to track students' clinical encounters to determine whether ...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2007.01206.x
更新日期:2007-07-01 00:00:00
abstract:OBJECTIVES:To determine the association between usages of proton pump inhibitors (PPIs) and subsequent risk of pneumonia in dementia patients. DESIGN:Retrospective cohort study. SETTING:Taiwanese National Health Insurance Research Database. PARTICIPANTS:The study cohort consisted of 786 dementia patients with new PP...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.14813
更新日期:2017-07-01 00:00:00
abstract::Investigations of the natural history of blood pressure have generally evaluated mean systolic and diastolic pressure changes. While information, this information is not directly applicable to clinical practice settings, in which patients are usually classified as normotensive or hypertensive. We measured the actual i...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
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更新日期:1989-09-01 00:00:00
abstract:OBJECTIVES:To examine the combined influence of alcohol use and comorbidity on 20-year mortality in older adults (average age 66 at the time of the baseline survey). DESIGN:Longitudinal analysis of a national probability sample-based cohort study. SETTING:Data sources were the National Health and Nutrition Examinatio...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2006.00728.x
更新日期:2006-05-01 00:00:00
abstract:OBJECTIVES:To describe the features of community-acquired pneumonia (CAP) requiring hospitalization in subjects receiving home care. DESIGN:Prospective study from November 15, 2000, to November 14, 2002. SETTING:Six hospitals in the Edmonton, Canada, area. PARTICIPANTS:Two thousand four hundred sixty-four subjects a...
journal_title:Journal of the American Geriatrics Society
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doi:10.1111/j.1532-5415.2005.53264.x
更新日期:2005-05-01 00:00:00
abstract::The safety and efficacy of current ACIP guidelines for the prevention and control of influenza in nursing home populations are uncertain. An outbreak of influenza A/Sichuan (H3N2) in a teaching nursing home during 1988 gave us the opportunity to evaluate the effectiveness of an influenza vaccination and amantadine pro...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
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更新日期:1989-03-01 00:00:00
abstract:OBJECTIVE:To examine public opinion regarding certain elements of consent: disclosure, advance directives, substitute decisions, emergency treatment, and advocacy. DESIGN:Cross-sectional random-digit-dialing telephonic survey. SETTING:General public. PARTICIPANTS:One thousand randomly-selected adults living in Ontar...
journal_title:Journal of the American Geriatrics Society
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更新日期:1993-02-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
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doi:10.1046/j.1532-5415.2003.51159.x
更新日期:2003-04-01 00:00:00
abstract::The relative importance of dementia, gender, age and functional status (FS) was examined for relationships to mortality within five years after admission of the subjects to a New York City nursing home for the aged. Using a random sample of 212 of the nursing home's patients, a statistical model was developed to estim...
journal_title:Journal of the American Geriatrics Society
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doi:10.1111/j.1532-5415.1981.tb03354.x
更新日期:1981-11-01 00:00:00
abstract:OBJECTIVES:Evidence suggests inflammation is associated with cognitive impairment, but previous epidemiological studies have reported conflicting results. DESIGN:Prospective population-based cohort. SETTING:Epidemiology of Hearing Loss Study participants. PARTICIPANTS:Individuals without cognitive impairment in 1998...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.12994
更新日期:2014-09-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2007.01159.x
更新日期:2007-05-01 00:00:00
abstract::Because the value of calcium supplementation in age-related bone loss is controversial, we conducted a study to examine the effects of six months of calcium supplementation on parathyroid hormone (PTH) and other indices of bone metabolism. Calcium carbonate (1.2 grams elemental calcium/day) or placebo was administered...
journal_title:Journal of the American Geriatrics Society
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1991-02-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.16692
更新日期:2020-10-01 00:00:00
abstract:OBJECTIVES:To explore and deepen understanding of factors influencing driving exposure for older drivers. DESIGN:Cross-sectional. SETTING:Baseline data on function and driving exposure from 1 week of driving were evaluated. PARTICIPANTS:A convenience sample of 380 drivers aged 75 and older, residing in northwest Syd...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.13440
更新日期:2015-06-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,多中心研究
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更新日期:2005-12-01 00:00:00
abstract:OBJECTIVES:Family caregiving is an integral part of the care system for persons with dementing disorders, such as Alzheimer's disease. This study tested role-training intervention as a way to help family caregivers appreciate and assume a more clinical belief set about caregiving and thereby ameliorate the adverse outc...
journal_title:Journal of the American Geriatrics Society
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2001-04-01 00:00:00
abstract:OBJECTIVES:To test the efficacy of an individualized social activity intervention (ISAI) on decreasing daytime sleep, improving nighttime sleep, and lowering the day/night sleep ratio and to determine its cost. DESIGN:Pretest/posttest randomized with an experimental and control group. SETTING:Seven nursing homes. PA...
journal_title:Journal of the American Geriatrics Society
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2005-09-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 临床试验,杂志文章
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更新日期:1994-12-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,评审
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更新日期:1998-12-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2003-02-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.15140
更新日期:2018-01-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
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更新日期:1999-03-01 00:00:00
abstract:OBJECTIVES:To assess whether older age is independently associated with hemorrhage risk in patients with atrial fibrillation, whether or not they are taking warfarin therapy. DESIGN:Cohort study. SETTING:Integrated healthcare delivery system. Thirteen thousand five hundred fifty-nine adults with nonvalvular atrial fi...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
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更新日期:2006-08-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1994.tb01749.x
更新日期:1994-03-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1985.tb07117.x
更新日期:1985-04-01 00:00:00
abstract:OBJECTIVES:To characterize a comprehensive outline of the oral microflora related to pneumonia in older adults. DESIGN:Prospective and retrospective longitudinal study. SETTING:Community. PARTICIPANTS:Long-term hospitalized patients and people in nursing homes (343 subjects, aged > or =65). MEASUREMENTS:Subjects we...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
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更新日期:2010-06-01 00:00:00
abstract:OBJECTIVES:To describe the prevalence of and characteristics associated with major and minor depression in older medical inpatients and to compare associated characteristics by sex and history of depression. DESIGN:Cross-sectional study of two patient samples, with and without a screening diagnosis of major or minor d...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2005.53404.x
更新日期:2005-08-01 00:00:00
abstract:OBJECTIVES:To use a simple measure of activities of daily living, wounds, and indwelling devices (urinary catheter, feeding tube) to predict prevalent, new, and intermittent multidrug-resistant organism (MDRO) acquisition in nursing home (NH) residents. DESIGN:Secondary analysis, prospective cohort study. SETTING:Sou...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.13353
更新日期:2015-04-01 00:00:00