DO ACUTE-CARE FOR ELDERS UNITS INCREASE HOSPITAL COSTS - A COST-ANALYSIS USING THE HOSPITAL PERSPECTIVE

OBJECTIVE: To compare the hospital costs of caring for medical patient s on a special unit designed to help older people maintain or achieve independence in self-care activities with the costs of usual care. DES IGN: A randomized controlled study. PARTICIPANTS: A total of 650 medic al patients (mean age 80 years, 67% women, 41% nonwhite) assigned rand omly to either the intervention unit (n = 326) or usual care (n = 324) . MEASURES: The hospital's resource-based cost of caring for patients was determined from the hospital's cost-accounting system. The cost of the intervention program was estimated and included in the interventi on patients' total hospital cost. RESULTS: The development and mainten ance costs of the intervention added $38.43 per bed day to the interve ntion patients' hospital costs. As a result, the cost per day to the h ospital was slightly higher in the intervention patients than in the c ontrol patients ($876 vs $847, P =.076). However, the average length o f stay was shorter for intervention patients (7.5 vs 8.4 days, P =.449 ). As a result, the hospital's total cost to care for intervention pat ients was not greater than caring for usual-care patients ($6608 in in tervention patients vs $7240 in control patients, P =.926). Sensitivit y analysis demonstrated that the cost of the intervention program woul d need to be 220% greater than estimated before intervention patients would be more expensive then control patients. There were no examined subgroups of patients in whom care on the intervention unit was signif icantly more expensive than care on the usual-care unit. Ninety-day nu rsing home use was lower in intervention than control patients (24.1% vs 32.3%, P =.034). Ninety-day readmission rates (36.7% vs 41.1%, P =. 283) and caregiver strain scores (3.3 vs. 2.7, P =.280) were similar. CONCLUSION: Caring for patients on an intervention ward designed to im prove functional outcomes in older patients was not more expensive to the hospital than caring for patients on a usual-care ward even though the intervention ward required a commitment of hospital resources.