No abstract

Background: To assess the development of and variation in lengths of stay in Dutch hospitals and to determine the potential reduction in hospital days if all Dutch hospitals would have an average length of stay equal to that of benchmark hospitals.

Objective. To test the hypothesis that physicians who work in different hospitals adapt their length of stay decisions to what is usual in the hospital under consideration. Data Sources. Secondary data were used, originating from the Statewide Planning and Research Cooperative System (SPARCS). SPARCS is a major management tool for assisting hospitals, agencies, and health care organizations with decision making in relation to financial planning and monitoring of inpatient and ambulatory surgery services and costs in New York state. Study Design. Data on length of stay for surgical interventions and medical conditions (a total of seven diagnosis-related groups [DRGs]) were studied, to find out whether there is more variation between than within hospitals. Data (1999Data ( , 2000Data ( , and 2001) from all hospitals in New York state were used. The study examined physicians practicing in one hospital and physicians practicing in more than one hospital, to determine whether average length of stay differs according to the hospital of practice. Multilevel models were used to determine variation between and within hospitals. A t-test was used to test whether length of stay for patients of each multihospital physician differed from the average length of stay in each of the two hospitals. Principal Findings. There is significantly ( po.05) more variation between than within hospitals in most of the study populations. Physicians working in two hospitals had patient lengths of stay comparable with the usual practice in the hospital where the procedure was performed. The proportion of physicians working in one hospital did not have a consistent effect for all DRGs on the variation within hospitals. Conclusion. Physicians adapt to their colleagues or to the managerial demands of the particular hospital in which they work. The hospital and broader work environment should be taken into account when developing effective interventions to reduce variation in medical practice.

This study describes a series of interventions linking hospitals, medical staff physicians, long-term care providers and mental health services in the metropolitan area of Syracuse, New York. The objectives of these interventions were to improve patient outcomes and systemwide efficiency. The study demonstrated that these linkages, including system-wide data feedback, contributed to limitation of emergency department overcrowding, reduction of physician lengths of stay, elimination of duplication of medical staff credentialing, as well as access to and efficiency of long-term care and mental health services.

No abstract

BackgroundIncreasingly, efforts are being made to link health care outcomes with more efficient use of resources. The current difficult economic times and health care reform efforts provide incentives for specific efforts in this area.FindingsThis study defined relationships between inpatient complications for urinary tract infection and pneumonia and hospital lengths of stay in three general hospitals in the metropolitan area of Syracuse, New York. It employed the Potentially Preventable Complications (PPC) software developed by 3M™ Health Information Services to identify lengths of stay for patients with and without urinary tract infection and pneumonia. The patient populations included individuals assigned to the same All Patients Refined Diagnosis Related Groups and severity of illness. The comparisons involved two nine month periods in 2008 and 2009.The study demonstrated that patients who experienced the complications had substantially longer inpatient hospital stays than those who did not. Patients with a PPC of urinary tract infection stayed a mean of 8.9 - 11.9 days or 161 - 216 percent longer than those who did not for the two time periods. This increased stay produced 2,020 - 2,427 additional patient days.The study demonstrated that patients who experienced the complications had substantially longer inpatient hospital stays than those who did not. Patients with a PPC of pneumonia stayed a mean of 13.0 - 16.3 days or 232 - 281 percent longer than those who did not for the two time periods. This increased stay produced 2,626 - 3,456 additional patient days. Similar differences were generated for median lengths of stay.ConclusionsThe differences in hospital stays for patients in the same APR DRGs and severity of illness with and without urinary tract infection and pneumonia in the Syracuse hospitals were substantial. The additional utilization for these complications was valued at between $2,000,000 - $3,000,000 for a three month period. These differences in the use of hospital resources have important implications for reduction of health care costs among providers and payors of care.

This approach focused on identifying specific variables that predict the likelihood of readmission. It involved clinical, utilization, and demographic variables that are generally available on hospital computer abstract databases. The approach included a process for identifying and comparing individual variables with the highest risk of readmission. It also contained a procedure for assembling risk populations including combinations of variables. The approach demonstrated the potential for using risk analysis to maximize the focus of clinical management on patient outcomes while reducing the amount of resources required for this process.

Major financial constraints on health care payors are increasing pressure on hospitals to become more efficient. This study described the use of common data formats and specific interventions with physicians and nursing homes to reduce inpatient lengths of stay by four hospitals in Syracuse, New York. These initiatives saved over 28,000 patient days and an average daily census of 96.0 over a 3.5-year period.