Raquel Barba1, Javier Marco2, Jesús Canora3, Susana Plaza4, Sara Nistal Juncos5, Juan Hinojosa6, Manuel Mendez Bailon7, Antonio Zapatero8. 1. Department of Internal Medicine, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain. Electronic address: raquel.barba@hospitalreyjuancarlos.es. 2. Department of Internal Medicine, Hospital Clínico de San Carlos, Madrid, Spain. Electronic address: javier.marco@elmundo.es. 3. Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain. Electronic address: jcanora.hflr@salud.madrid.org. 4. Department of Internal Medicine, Hospital Severo Ochoa, Leganés, Madrid, Spain. Electronic address: splaza.hsvo@salud.madrid.org. 5. Department of Internal Medicine, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain. Electronic address: sara.nistal@hospitalreyjuancalos.es. 6. Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain. Electronic address: jhinojosa.hflr@salud.madrid.org. 7. Department of Internal Medicine, Hospital Clínico de San Carlos, Madrid, Spain. Electronic address: manuel.mendez@salud.madrid.org. 8. Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain. Electronic address: azapatero.hflr@salud.madrid.org.
Abstract
BACKGROUND: Targeting patients with prolonged hospitalizations may represent an effective strategy for reducing average hospital length of stay (LOS). OBJECTIVE: We sought to characterize predictors of prolonged hospitalization among internal medicine patients in an effort to guide future improvement efforts. DESIGN: We conducted a retrospective cohort study using administrative data of internal medicine patients from all hospitals of the Spanish Public Health Service between January 1st, 2005 and December 31st, 2013. Multivariable logistic regression was performed to assess the association between sociodemographic and clinical variables and prolonged LOS, defined as >30days. KEY RESULTS: Of 5,275,139 discharges, 166,470 (3.2%) had a prolonged LOS. Prolonged hospitalizations accounted for 17.4% of total inpatient days and contributed 0.5days to an average LOS of 9.8days during the study period. Prolonged hospitalizations were associated with younger age (odds ratio [OR]: 0.97 per 10-year increase in age, 95% confidence interval [CI]: 0.96-0.98) and male gender (OR 0.88 IC95% 0.87-0.89). Compared to patients without prolonged LOS, prolonged LOS patients were more likely to require a palliative care consult (OR: 2.48, 95% CI: 2.39-2.58), surgery (OR: 6.9 95% CI: 6.8-7.0); and be discharged to a post-acute-care facility (OR: 2.91, 95% CI: 2.86-2.95). CONCLUSIONS: Prolonged hospitalizations in a small proportion of patients were an important contributor to overall LOS and particularly affected complex hospital stays who were not discharged home.
BACKGROUND: Targeting patients with prolonged hospitalizations may represent an effective strategy for reducing average hospital length of stay (LOS). OBJECTIVE: We sought to characterize predictors of prolonged hospitalization among internal medicine patients in an effort to guide future improvement efforts. DESIGN: We conducted a retrospective cohort study using administrative data of internal medicine patients from all hospitals of the Spanish Public Health Service between January 1st, 2005 and December 31st, 2013. Multivariable logistic regression was performed to assess the association between sociodemographic and clinical variables and prolonged LOS, defined as >30days. KEY RESULTS: Of 5,275,139 discharges, 166,470 (3.2%) had a prolonged LOS. Prolonged hospitalizations accounted for 17.4% of total inpatient days and contributed 0.5days to an average LOS of 9.8days during the study period. Prolonged hospitalizations were associated with younger age (odds ratio [OR]: 0.97 per 10-year increase in age, 95% confidence interval [CI]: 0.96-0.98) and male gender (OR 0.88 IC95% 0.87-0.89). Compared to patients without prolonged LOS, prolonged LOS patients were more likely to require a palliative care consult (OR: 2.48, 95% CI: 2.39-2.58), surgery (OR: 6.9 95% CI: 6.8-7.0); and be discharged to a post-acute-care facility (OR: 2.91, 95% CI: 2.86-2.95). CONCLUSIONS: Prolonged hospitalizations in a small proportion of patients were an important contributor to overall LOS and particularly affected complex hospital stays who were not discharged home.
Authors: Gregory C Jones; Joseph G Timmons; Scott G Cunningham; Stephen J Cleland; Christopher A R Sainsbury Journal: J Diabetes Sci Technol Date: 2017-01-09
Authors: Joon Young Choi; Young Soo Park; Gyeongjae Na; Sung Jae Park; Hyuk Yoon; Cheol Min Shin; Nayoung Kim; Dong Ho Lee Journal: Medicine (Baltimore) Date: 2019-08 Impact factor: 1.817