Most frequent reasons for hospitalization among elderly individuals

Heart and respiratory conditions, such as congestive heart failure and pneumonia, were consistently among the most common reasons for hospitalizations among elderly individuals between 1997 and 2004. Table 2 presents a list of the top 10 reasons for hospitalization in 1997, 2000, and 2004. These top 10 conditions accounted for nearly 40 percent of elderly hospitalizations each year.

Table 2

Top 10 reasons for hospitalizations among the elderly, 1997, 2000, and 2004.

Trends in hospital costs and ALOS for select conditions

Hospital costs increased across the years for each of the six select conditions that are the focus of this brief: congestive heart failure (CHF), pneumonia, acute myocardial infarction or heart attack (AMI), chronic obstructive pulmonary disease (COPD), acute cerebrovascular disease (stroke), and osteoarthritis. Figure 1 presents the changes in hospital costs for these six select conditions from 1997 to 2004. Specifically, hospital costs for CHF increased by about 48 percent—from $6,200 per stay in 1997 to $9,200 per stay in 2004. AMI also experienced a large cost increase of over $4,000 per hospital stay (from $11,900 in 1997 to $16,000 in 2004). Stroke and osteoarthritis both increased by over $2,000 per stay. For pneumonia and COPD, the average hospital cost increased by approximately $1,000 per stay.

Figure 1

Hospital costs increased for six select conditions among the elderly, 1997 to 2004. *Based on principal diagnosis. Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 1997, (more...)

While hospital costs increased over time, hospital stays for each select condition were shorter in 2004 relative to 1997—dropping by 0.4 to 1.5 days, depending on the condition. In 2004, the ALOS for these six conditions ranged from 4 days to 6 days. Figure 2 presents the ALOS for these six select conditions in 1997, 2000, and 2004. The conditions with the greatest cost increases, CHF and AMI, experienced the smallest declines in ALOS: 0.4 days and 0.5 days, respectively. Pneumonia and stroke, the two diagnoses with the longest ALOS in 1997, experienced the greatest decreases in ALOS in 2004 (1 day and 1.5 days, respectively).

Figure 2

Average length of stay (ALOS) decreased for six select conditions among the elderly, 1997, 2000, and 2004. *Based on principal diagnosis. Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide (more...)

Trends in admissions through the ED for select conditions

From 1997 to 2004, the rate of hospital admissions initiated in the ED increased for all six select conditions. Hospitalizations for these conditions tended to originate in the ED more often, relative to other causes of elderly hospitalizations. Figure 3 presents the percentage of hospitalizations that originated in the ED for these select conditions in 1997, 2000, and 2004. With the exception of osteoarthritis, a condition for which there is typically a low rate of hospital admissions from the ED, hospitalizations commonly began in the ED in 2004, ranging from 67 percent of stays for AMI to 78 percent of stays for stroke. Among the six conditions, the three diagnoses that experienced the greatest increase in admissions from the ED (on average a 15 percent rise from 1997) were pneumonia, COPD, and stroke.

Figure 3

Hospitalizations originating in the emergency department (ED) increased for select conditions among the elderly, 1997, 2000, and 2004*. *Based on principal diagnosis. Note: A small percentage of hospitalizations for osteoarthritis originated in the ED—2 (more...)

Types of hospitals included in HCUP

HCUP is based on data from community hospitals, defined as short-term, non-Federal, general and other hospitals, excluding hospital units of other institutions (e.g., prisons). HCUP data include OB-GYN, ENT, orthopedic, cancer, pediatric, public, and academic medical hospitals. They exclude long-term care, rehabilitation, psychiatric, and alcoholism and chemical dependency hospitals, but these types of discharges are included if they are from community hospitals.

Unit of analysis

The unit of analysis is the hospital discharge (i.e., the hospital stay), not a person or patient. This means that a person who is admitted to the hospital multiple times in one year will be counted each time as a separate “discharge” from the hospital.

Costs and charges

Total hospital charges were converted to costs using cost-to-charge ratios (CCR) based on hospital accounting reports from the Centers for Medicare and Medicaid Services (CMS).⁵ Costs will tend to reflect the actual costs of production, while charges represent what the hospital billed for the case. For each hospital, a hospital-wide CCR is used because detailed charges are not available across all HCUP States. Hospital charges reflect the amount the hospital charged for the entire hospital stay and does not include professional (physician) fees.

For the purposes of this Statistical Brief, all cost data have been presented in 2004 dollars using the Bureau of Labor Statistics Consumer Price Index All Urban Consumers (CPI-U) U.S. city average and reported to the nearest hundreds. (Note: Costs for 2004 data are imputed from the 2003 CCR file and costs for the 1998 data are imputed from the 1997 CCR file.)

Principal diagnosis and Clinical Classifications Software (CCS)

The principal diagnosis is that condition established after study to be chiefly responsible for the patient’s admission to the hospital. Secondary diagnoses are concomitant conditions that coexist at the time of admission or that develop during the stay. All-listed diagnoses include the principal diagnosis plus these additional secondary conditions. The conditions presented in this brief are based on the principal diagnosis.

ICD-9-CM is the International Classification of Diseases, Ninth Revision, Clinical Modification, which assigns numeric codes to diagnoses. There are about 12,000 ICD-9-CM diagnosis codes. CCS categorizes ICD-9-CM diagnoses into 260 clinically meaningful categories. This “clinical grouper” makes it easier to quickly understand patterns of diagnoses and procedures.

The conditions detailed in this brief were defined by CCS principal diagnosis codes. The following CCS diagnosis codes were used to identify the six select conditions:

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100 Acute myocardial infarction (AMI) (heart attack)

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108 Congestive heart failure

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109 Acute cerebrovascular disease (stroke)

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122 Pneumonia

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127 Chronic obstructive pulmonary disease (COPD)

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203 Osteoarthritis