Determinants of Post-acute Care Costs in Acutely Hospitalized Older Adults: The Hospital-ADL Study

Marthe E. Ribbink*, Rosanne van Seben, Lucienne A. Reichardt, Jesse J. Aarden, Marike van der Schaaf, Martin van der Esch, Raoul H.H. Engelbert, Jos W.R. Twisk, Jos A. Bosch, Janet L. MacNeil Vroomen, Bianca M. Buurman, Hospital-ADL study group

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objectives: After hospitalization, many older adults need post-acute care, including rehabilitation or home care. However, post-acute care expenses can be as high as the costs for the initial hospitalization. Detailed information on monthly post-acute health care expenditures and the characteristics of patients that make up for a large share of these expenditures is scarce. We aimed to calculate costs in acutely hospitalized older patients and identify patient characteristics that are associated with high post-acute care costs. Design: Prospective multicenter cohort study (between October 2015 and June 2017). Setting and participants: 401 acutely hospitalized older persons from internal medicine, cardiology, and geriatric wards. Measurements: Our primary outcome was mean post-acute care costs within 90 days postdischarge. Post-acute care costs included costs for unplanned readmissions, home care, nursing home care, general practice, and rehabilitation care. Three costs categories were defined: low [0-50th percentile (p0-50)], moderate (p50-75), and high (p75-100). Multinomial logistic regression analyses were conducted to assess the associations between costs and frailty, functional impairment, health-related quality of life, cognitive impairment, and depressive symptoms. Results: Costs were distributed unevenly in the population, with the top 10.0% (n = 40) accounting for 52.1% of total post-acute care costs. Mean post-acute care costs were €4035 [standard deviation (SD) 4346] or $4560 (SD 4911). Frailty [odds ratio (OR) 3.44, 95% confidence interval (CI) 1.78-6.63], functional impairment (OR 1.80, 95% CI 1.03-3.16), and poor health-related quality of life (OR 1.89, 95% CI 1.09-3.28) at admission were associated with classification in the high-cost group, compared with the low-cost group. Conclusions/Implications: Post-acute care costs are substantial in a small portion of hospitalized older adults. Frailty, functional impairment, and poor health-related quality of life are associated with higher post-acute care costs and may be used as an indicator of such costs in practice.

Original languageEnglish
Pages (from-to)1300-1306.e1
JournalJournal of the American Medical Directors Association
Volume20
Issue number10
DOIs
Publication statusPublished - 1 Oct 2019

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