Trends in hospital utilization and outcome for patients with ALS: analysis of a large U.S. cohort

To examine hospital mortality, utilization, and trends in care of patients with ALS in a large U.S. cohort.

The authors performed a retrospective cohort comparison, using the Nationwide Inpatient Sample for 1988 to 2002. They identified admissions, comorbidities, and procedures using ICD-9 codes. Outcomes included reason for admission, cost (adjusted to 2002 dollars), length of stay, discharge disposition, and utilization of hospice care. Significance was set a priori at p < 0.001.

They identified 17,249 records. The significant findings were that common morbidities increased over time (pneumonia [38.1% to 47.3%], respiratory failure [26.9% to 35.5%], and nutritional deficiency [43.0% to 56.3%]); the median length of stay dropped from 6 to 4 days; mean hospital charges increased from 21,574 dollars to 24,314 dollars; the proportion of hospital deaths decreased over time (17.6% to 14.6%), whereas the proportion discharged to home health/hospice care (14.0% to 18.2%) and to long-term care facilities (13.2% to 27.9%) increased. The odds ratio (OR) of death was 5.03 (95% CI: 4.57 to 5.54) for those admitted with respiratory failure, 1.36 (1.24 to 1.50) for those with pneumonia, and 0.84 (0.77 to 0.92) for those with nutritional deficiency.

The high OR of death in patients admitted for pneumonia or respiratory failure is likely associated with more advanced disease, whereas the protective effect of admission for nutritional deficiency is consistent with the predominance of bulbar symptoms and admission earlier in the disease. The trends during the 15 years of this administrative data set were for increasing comorbidities and higher utilization of end-of-life care.