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Chronic disabling disease--impact on outcomes and costs in emergency medical admissions
S Cournane1, D Byrne2, D O'Riordan2
1From the Medical Physics and Bioengineering Department, Division of Internal Medicine and Office of the CEO, St. James's Hospital, Dublin 8, Ireland scournane@stjames.ie.
Insights
Chronic disabling disease significantly impacts hospital length of stay and costs for emergency admissions. Its effect on mortality is primarily seen in patients with multiple chronic conditions.
Area of Science:
- Medical research
- Health services research
- Public health
Background:
- Chronic disabling diseases affect nearly 90% of emergency medical admissions.
- Understanding the impact of chronic conditions on healthcare outcomes is crucial.
Purpose of the Study:
- To examine the impact of chronic disabling disease on outcomes and costs in emergency medical admissions.
- To identify chronic disease as a predictor of mortality, length of stay, and hospital costs.
Main Methods:
- Prospective analysis of 66,933 emergency admissions over 12 years (2002-2013).
- Evaluation of 30-day in-hospital mortality, length of stay (LOS), and hospital costs.
- Multivariable logistic regression and zero-truncated Poisson regression were used.
Main Results:
- Acute illness severity was the strongest predictor of mortality.
- Chronic disabling disease independently predicted increased LOS and hospital costs, particularly with multiple conditions.
- Age was only independently predictive of mortality for patients 85+ years.
Conclusions:
- Chronic disabling disease is an independent predictor of LOS and costs in emergency admissions.
- Its role as a mortality predictor is significant mainly for patients with multiple chronic conditions.
- Healthcare resource utilization and patient outcomes are significantly influenced by chronic disease burden.
Background:
Chronic disabling disease is present in nearly 90% of emergency medical admissions. We have examined its impact on outcomes and costs in one institution, using a database of episodes collected prospectively over 12 years.
Methods:
All emergency admissions (66,933 episodes; 36,271 patients) to St James' Hospital over a 12-year period (2002-13) were evaluated in relation to 30-day in-hospital mortality, length of stay (LOS) and hospital costs. Predictor variables (identified univariately) were entered into a multi-variable logistic regression model to predict 30-day in-hospital mortality. The data were also modelled as count data (absolute LOS, total cost) using zero-truncated Poisson regression.
Results:
Acute illness severity was the best independent predictor of mortality; chronic disabling disease was an independent predictor (P < 0.001) for patients with 4+ disabling conditions. Age, adjusted for other predictors, was only independently predictive of mortality for patient 85+ years. Chronic disabling disease was an independent predictor of LOS increasing linearly with incidence rate ratios of 1.35 (95% CI: 1.29, 1.42), 1.59 (95% CI: 1.51, 1.66), 1.73 (95% CI: 1.65, 1.83) and 1.74 (95% CI: 1.65, 1.84) for those with 1, 2, 3 or 4+ disabling conditions, respectively. Age, as a predictor of LOS was strongly correlated with the presence of disabling disease. Chronic disabling disease independently predicted costs non-linearly; those with 2 or more disabling conditions had particularly high total hospital costs.
Conclusion:
Chronic disabling disease is an independent predictor of hospital LOS and costs in unselected emergency admissions; adjusted for illness severity, it is only a mortality predictor for those with multiple disabling conditions.
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