Long-stay patients in short-stay hospitals.

In 1980 and 1990, only 4-5 percent of patients in short-stay hospitals were hospitalized for more than 3 weeks. The number of discharges and days of care for these long-stay patients were lower in 1990 as compared with 1980, but they continued to use more than a quarter of all hospital days in 1990. Long-stay patients were more likely than all patients to be 65 years of age and over and have Medicare as their expected principal source of payment. For long-stay and all patients, private insurance covered smaller proportions of discharges and days of care, and Medicaid covered larger proportions in 1990 than in 1980. Long-stay patients were more likely than all patients to be discharged dead or transferred to other hospitals or nursing homes. Long-stay and all patients were more likely to be transferred at discharge in 1990 than in 1981. The Northeast Region had a larger proportion of long-stay patients than of all patients, and that proportion increased from 1980 to 1990. The proportion of long-stay discharges and days of care in the Midwest decreased during this period. In 1980 and 1990, more than 50 percent of the discharges and days of care for long-stay patients were for diseases of the circulatory system, mental disorders, neoplasms, or injury and poisoning. Despite the overall decreases in hospital use by long-stay patients, their discharges and days of care increased significantly from 1980 to 1990 for diagnoses such as septicemia, psychoses, and miscellaneous complications of surgical and medical care. Over time, decreases were seen in long-stay discharges and days of care for a variety of diagnostic categories, including malignant neoplasm of trachea, bronchus, and lung; diabetes mellitus; and fracture of the neck of the femur. Long-stay patients had a higher rate of procedures per 1,000 discharges in 1990 than in 1980, and a higher rate than all patients in both years. Approximately half of all the procedures performed on long-stay patients in 1980 and two-thirds in 1990 were miscellaneous diagnostic and therapeutic procedures, operations on the cardiovascular system, or operations on the digestive system. The rates of numerous procedures, especially diagnostic tests, increased for long-stay and all patients from 1980 to 1990.