P-1921. Nursing Home Resident Hospitalizations Related to Infection, Medicare Claims, 2022

TL;DR

Infections account for over 40% of hospitalizations among nursing home residents, leading to higher costs, longer stays, and more deaths compared to non-infection cases.

Contribution

The study quantifies the burden of infection-related hospitalizations among nursing home residents using Medicare claims data.

Findings

Infections accounted for 41% of hospitalizations, with sepsis being the most common.

Infection-related hospitalizations had longer stays, higher costs, and higher mortality than non-infection cases.

Non-infection hospitalizations were most commonly due to circulatory, digestive, respiratory, and nervous system issues.

Abstract

Quantifying the relative burden of infections among hospitalizations from nursing home residents can inform prevention strategies.Infection hospitalizations stratified by primary diagnosis categorization using the diagnosis codes listed in Centers for Medicare and Medicaid Services’ skilled nursing facility healthcare-associated infections requiring hospitalization measure (1).Characterization of hospitalizations without a primary diagnosis of infection (1) grouped by major diagnostic category (2).

Infection hospitalizations stratified by primary diagnosis categorization using the diagnosis codes listed in Centers for Medicare and Medicaid Services’ skilled nursing facility healthcare-associated infections requiring hospitalization measure (1).

Characterization of hospitalizations without a primary diagnosis of infection (1) grouped by major diagnostic category (2).

We used MedPAR files to identify Medicare claims for unplanned inpatient hospital admissions. We included all hospitalizations with an admission date during or within one day of a nursing home stay (identified using assessments in the Minimum Dataset 3.0). We categorized infection-related hospitalizations by type using the primary diagnosis code, similar to a Medicare skilled nursing facility quality measure, healthcare-associated infections requiring hospitalization. We described the remaining non-infection hospitalizations using Major Diagnostic Categories (MDCs). Resident age, sex, hospitalization costs, and other characteristics were compared among those with infection-related and non-infection hospitalizations using chi-square and Wilcoxon rank-sum tests.

We identified 706,875 hospital admissions among 494,611 nursing home residents in 2022. Among these, 286,446 (41%) had a primary diagnosis of an infection. The most frequent infection-related categorizations included sepsis (n=173,013, 60%), respiratory (n=53,288, 19%), device-related (n=28436, 10%), and genitourinary infections (n=23,089, 8%) (Figure 1). Of the non-infection hospitalizations, the most common MDCs were diseases and disorders of the circulatory (n=84,890, 20%), digestive (n=52,174, 12%), respiratory (n=52,021, 12%), and nervous systems (n=50,893, 12%) (Figure 2). For all hospital admissions, the mean beneficiary age was 77 years, 393,562 (56%) were females, and 301,460 (43%) had been hospitalized within the previous 30 days.

Hospitalizations with a primary diagnosis of an infection had a longer median length of stay (6 vs 5 days), higher median claim cost ($10,905 vs $8,051), a higher proportion with intensive care unit admission (24% vs 12%), and higher proportion of death at discharge (14% vs 6%) than non-infection hospitalizations (all p< 0.001).

Infection-related primary diagnoses constituted over 40% of all hospitalizations among nursing home residents and have increased morbidity and mortality. Prevention of infections among nursing home residents across healthcare settings may improve wellbeing.

All Authors: No reported disclosures

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