Does hospitalization impact survival after lower respiratory infection in nursing home residents?

Robin L. Kruse, David R. Mehr, Keith E. Boles, Judith R. Lave, Ellen F. Binder, Richard Madsen, Ralph B. D'Agostino

Research output: Contribution to journalArticlepeer-review

78 Scopus citations


Background: Lower respiratory infection (LRI) is the leading cause of hospitalization for nursing home residents, but hospitalization is costly and may cause complications. Objective: We sought to compare mortality and cost between episodes of LRI initially treated in the hospital versus the nursing home after controlling for illness severity and the probability of hospitalization. Design: This was a prospective cohort study of nursing home residents with LRIs. Subjects: We identified 1406 episodes of LRI in 36 nursing homes in central Missouri and the St. Louis area between August 15, 1995, and September 30, 1998. Economic analysis was restricted to 1033 episodes identified after March 31, 1997. Measures: We adjusted for the higher probability of initial hospitalization in sicker residents using measures of illness severity and a hospitalization propensity score. The propensity score was derived from a logistic regression model that included patient, physician, and facility variables. Estimated costs were attributed to initial treatment setting. Results: After controlling for the probability of hospitalization and illness severity, hospitalization was not a significant mortality predictor (odds ratio 0.89, 95% confidence interval 0.52-1.52). Mean daily cost was $138.24 for initial nursing home treatment and $419.75 for the hospital. Conclusions: After controlling for illness severity and propensity for hospitalization, hospital treatment is not associated with either increased or decreased risk for mortality for nursing home residents with LRIs. For residents with low and medium mortality risk, nursing home treatment is likely to be safe and less costly.

Original languageEnglish
Pages (from-to)860-870
Number of pages11
JournalMedical care
Issue number9
StatePublished - Sep 2004


  • Cost analysis
  • Logistic regression
  • Modeling
  • Mortality
  • Nursing homes
  • Respiratory infections


Dive into the research topics of 'Does hospitalization impact survival after lower respiratory infection in nursing home residents?'. Together they form a unique fingerprint.

Cite this