Address correspondence to Marita G. Titler, Ph.D., R.N., F.A.A.N., Senior Assistant Director, University of Iowa Hospitals and Clinics, Director, Research, Quality and Outcomes Management, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, RM T100 GH. Gwenneth A. Jensen, R.N., M.N., C.N.S., Doctoral Student, is with the University of Iowa College of Nursing. Joanne McCloskey Dochterman, Ph.D., R.N., F.A.A.N., Professor Emeritus, is with the University of Iowa College of Nursing, Swisher, IA. Xian-Jin Xie, Ph.D., Assistant Professor of Biostatistics, is with the Center for Biostatistics and Clinical Science & Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX. Mary Kanak, R.N., Ph.D., Graduate Research Assistant, is with the University of Iowa College of Nursing, Iowa City, IA. David Reed, Ph.D., Statistician, is with the Office for Nursing Research, and the Interventions and Outcomes Project, University of Iowa College of Nursing, Iowa City, IA. Leah L. Shever, R.N., Ph.D.(c), Advanced Practice Nurse, Research, Quality and Outcomes Management, is with the Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, IA.
Cost of Hospital Care for Older Adults with Heart Failure: Medical, Pharmaceutical, and Nursing Costs
Article first published online: 12 OCT 2007
© Health Research and Educational Trust
Health Services Research
Volume 43, Issue 2, pages 635–655, April 2008
How to Cite
Titler, M. G., Jensen, G. A., Dochterman, J. M., Xie, X.-J., Kanak, M., Reed, D. and Shever, L. L. (2008), Cost of Hospital Care for Older Adults with Heart Failure: Medical, Pharmaceutical, and Nursing Costs. Health Services Research, 43: 635–655. doi: 10.1111/j.1475-6773.2007.00789.x
- Issue published online: 12 OCT 2007
- Article first published online: 12 OCT 2007
- Heart failure;
- hospital cost;
- RN staffing
Objective. To determine the impact of patient characteristics, clinical conditions, hospital unit characteristics, and health care interventions on hospital cost of patients with heart failure.
Data Sources/Study Setting. Data for this study were part of a larger study that used electronic clinical data repositories from an 843-bed, academic medical center in the Midwest.
Study Design. This retrospective, exploratory study used existing administrative and clinical data from 1,435 hospitalizations of 1,075 patients 60 years of age or older. A cost model was tested using generalized estimating equations (GEE) analysis.
Data Collection/Extraction Methods. Electronic databases used in this study were the medical record abstract, the financial data repository, the pharmacy repository; and the Nursing Information System repository. Data repositories were merged at the patient level into a relational database and housed on an SQL server.
Principal Findings. The model accounted for 88 percent of the variability in hospital costs for heart failure patients 60 years of age and older. The majority of variables that were associated with hospital cost were provider interventions. Each medical procedure increased cost by $623, each unique medication increased cost by $179, and the addition of each nursing intervention increased cost by $289. One medication and several nursing interventions were associated with lower cost. Nurse staffing below the average and residing on 2–4 units increased hospital cost.
Conclusions. The model and data analysis techniques used here provide an innovative and useful methodology to describe and quantify significant health care processes and their impact on cost per hospitalization. The findings indicate the importance of conducting research using existing clinical data in health care.