Dementia hospital length-of-stay and cost

Abstract

Alzheimer's prevalence is 5.1 million; expected to double by 2050. Medicare spends $160 billion. Objective: Compare care patterns for hospitalized dementia vs non-dementia patients longitudinally in an integrated healthcare system. Methods: 106,283 hospitalized dementia (predominantly Alzheimers) and matched non-dementia patients from Kaiser Northern California. Analysis was random effects GLS regression. Results: Mean age 77 with 31% dementia vs 10% nondementia patients over 85 years. 82% dementia vs 69% non-dementia hospitalizations were urgent. Dementia diagnosis code was primarily the third listed. Dementia diagnosis is a significant predictor of hospital LOS, increasing stay by 0.46 days (CI:0.5403-0.3831;p=0.000). Alzheimers diagnosis accounted for less LOS increase than cerebral vascular dementia. Pneumonia was the most frequent DRG diagnosis for dementia and second for non-dementia hospitalizations. Costs for the most frequent principal diagnosis were the same, but for the second most frequent ICD9:599.0 (urinary tract infection), dementia patients stayed 1.57 days longer; costing $1,000 more than non-dementia patients. LOS differences are significantly affected by co-morbidities (p=0.000). Conclusion: Dementia is a significant predictor of LOS but varies by dementia type. Efficient management of hospitalized dementia patients should focus on selected associated co-morbidities.