William N Southern1, Julia H Arnsten. 1. Department of Medicine, Division of Hospital Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA, wsouther@montefiore.org.
Abstract
BACKGROUND: Since the introduction of the prospective payment system in 1983, U.S. hospitals have been financially incentivized to reduce inpatient length of stay, and average length of stay has shortened dramatically. OBJECTIVE: The purpose of this study was to determine whether short length of stay is associated with worse patient outcomes. DESIGN: We used a quasi-experimental design to compare the outcomes of admissions assigned to physicians with short versus long length-of-stay tendencies. We used each physician's mean length of stay to define their length of stay tendency. We then compared the outcomes of admissions assigned to physicians with short versus long length-of-stay tendencies in propensity score-matched and adjusted analyses using mixed-effects and conditional logistic regression models. PATIENTS: The study included all admissions for 10 common diagnoses among patients admitted to the medical teaching service of an urban academic hospital from 7/1/2002 through 6/30/2008. MAIN MEASURE: The primary outcome was 30-day mortality. RESULTS: We examined 12,341 admissions among 79 physicians. After propensity score matching, admission groups were similar with respect to all demographic and clinical characteristics. Admissions of patients receiving care from short length-of-stay physicians were associated with significantly increased risk of 30-day mortality in adjusted (OR 1.43, 95 % CI: 1.11-1.85), propensity score-matched (OR 1.33, 95 % CI: 1.08-1.63), and matched and adjusted analyses (OR 1.36, 95 % CI: 0.98-1.90). CONCLUSIONS: Policies that incentivize short length of stay may lead to worse patient outcomes. The financial benefits of shortening inpatient length of stay should be weighed against the potential harm to patients.
BACKGROUND: Since the introduction of the prospective payment system in 1983, U.S. hospitals have been financially incentivized to reduce inpatient length of stay, and average length of stay has shortened dramatically. OBJECTIVE: The purpose of this study was to determine whether short length of stay is associated with worse patient outcomes. DESIGN: We used a quasi-experimental design to compare the outcomes of admissions assigned to physicians with short versus long length-of-stay tendencies. We used each physician's mean length of stay to define their length of stay tendency. We then compared the outcomes of admissions assigned to physicians with short versus long length-of-stay tendencies in propensity score-matched and adjusted analyses using mixed-effects and conditional logistic regression models. PATIENTS: The study included all admissions for 10 common diagnoses among patients admitted to the medical teaching service of an urban academic hospital from 7/1/2002 through 6/30/2008. MAIN MEASURE: The primary outcome was 30-day mortality. RESULTS: We examined 12,341 admissions among 79 physicians. After propensity score matching, admission groups were similar with respect to all demographic and clinical characteristics. Admissions of patients receiving care from short length-of-stay physicians were associated with significantly increased risk of 30-day mortality in adjusted (OR 1.43, 95 % CI: 1.11-1.85), propensity score-matched (OR 1.33, 95 % CI: 1.08-1.63), and matched and adjusted analyses (OR 1.36, 95 % CI: 0.98-1.90). CONCLUSIONS: Policies that incentivize short length of stay may lead to worse patient outcomes. The financial benefits of shortening inpatient length of stay should be weighed against the potential harm to patients.
Authors: Brent K Hollenbeck; David C Miller; David A Taub; Rodney L Dunn; Shukri F Khuri; William G Henderson; James E Montie; Willie Underwood; John T Wei Journal: J Urol Date: 2006-10 Impact factor: 7.450
Authors: Peter K Lindenauer; Michael B Rothberg; Penelope S Pekow; Christopher Kenwood; Evan M Benjamin; Andrew D Auerbach Journal: N Engl J Med Date: 2007-12-20 Impact factor: 91.245
Authors: Cinzia Maraldi; Stefano Volpato; Stephen B Kritchevsky; Matteo Cesari; Elena Andresen; Christiaan Leeuwenburgh; Tamara B Harris; Anne B Newman; Alka Kanaya; Karen C Johnson; Nicolas Rodondi; Marco Pahor Journal: Arch Intern Med Date: 2006-07-24
Authors: Scott E Regenbogen; Anne H Cain-Nielsen; Edward C Norton; Lena M Chen; John D Birkmeyer; Jonathan S Skinner Journal: JAMA Surg Date: 2017-05-17 Impact factor: 14.766
Authors: Jonathan M Wai; Christopher Aloezos; Wenzhu B Mowrey; Sarah W Baron; Regina Cregin; Howard L Forman Journal: J Subst Abuse Treat Date: 2019-01-23
Authors: Katie Harron; Ruth Gilbert; David Cromwell; Sam Oddie; Jan van der Meulen Journal: Paediatr Perinat Epidemiol Date: 2017-04-18 Impact factor: 3.980