• Robin L Kruse, Keith E Boles, David R Mehr, Diane Spalding, and Judith R Lave.
• Department of Family and Community Medicine, University of Missouri-Columbia, MO, USA.
• J Am Med Dir Assoc. 2003 Mar 1;4(2):81-9.

ObjectiveTo determine the costs of treating pneumonia in the nursing home setting and explore what factors are most responsible for that cost with a view to reducing cost.DesignProspective cohort study.SettingThirty-six Missouri nursing homes participating in the study from April 1997 through September 1998.ParticipantsNursing home residents with pneumonia who were not hospitalized (n = 502). We included residents evaluated in the emergency department (ED) and returned to the nursing home without admission.MeasurementsResidents were evaluated by project nurses. Examination findings, diagnostic testing, and treatment information for 30 days following evaluation were abstracted from medical records. Bills were obtained for individuals evaluated in the ED.ResultsThere was significant variation in the cost of treating pneumonia in nursing homes. Episode costs were higher for residents seen in the ED of a hospital, residents with decubitus ulcers, black residents, and residents in larger facilities. Although total episode costs were related to illness severity, most of the variation in cost is not explained by resident or illness characteristics. The average cost for treating an episode of pneumonia in the nursing home, over and above usual care, was $458.ConclusionsThere is wide variation in treatment for residents with similar clinical presentations. For residents at low risk of mortality, using less expensive antibiotics and reducing ED evaluation could result in cost reductions, although the effect on outcomes is unknown.

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