Trends in hospital discharge disposition for elderly patients with infective endocarditis: 1993 to 2003.

OBJECTIVES: To examine hospital discharges of elderly patients hospitalized with infective endocarditis (IE).

DESIGN: A retrospective analysis of hospital discharges from 1993 to 2003.

SETTING: The Nationwide Inpatient Sample (NIS), which approximates a 20% sample of all U.S. acute care hospitals.

PARTICIPANTS: All patients aged 65 and older with a primary or secondary International Classification of Diseases, Ninth Revision, diagnosis code for IE were included.

MEASUREMENTS: The main outcome measures were in-hospital mortality and, for survivors, discharge disposition: to home (with home health care) or to a facility.

RESULTS: Hospitalizations for IE increased 26.0% over the 10-year period, from 3.19 per 10,000 elderly patients in 1993 to 3.95 per 10,000 in 2003. Over the study period, a trend toward increasing discharge to nursing home and decreasing discharge to home and home health care was evident. Discharge to home for survivors decreased from 57.7% to 35.0% over the study period, whereas discharge to nursing facilities increased from 27.7% to 44.3%. Over the 10-year study period, elderly patients hospitalized with IE were 2.3 times as likely to be discharged to a facility as to home.

CONCLUSION: Hospital discharge dispositions have changed for elderly patients admitted with IE. Changes in the patient's age, severity of illness, or comorbidities do not explain these trends. Financial incentives are the most likely factor influencing the substitution in discharge dispositions for elderly patients with IE.