Computer-generated Informational Messages Directed to Physicians: Effect on Length of Hospital Stay

Abstract

Obiective: letWith the advent of hospital payment by diagnosis-related group (DRG), length of stay (LOS) has become a major issue in hospital efforts to control costs. Because the Columbia-Presbyterian Medical Center (CPMC) has had above-average LOSS for many DRGs, the authors tested the hypothesis that a computer-generated informational message directed to physicians would shorten LOS.Design: Randomized clinical trial with the patient as the unit of randomization.Setting and Study Population: From June 1991 to April 1993, at CPMC in New York, 7,109 patient admissions were randomly assigned to an intervention (informational message) group and 6,990 to a control (no message) group. Intervention:A message giving the average LOS for the patient's admission or provisional DRG, as assigned by hospital utilization review, and the current LOS, in days, was included in the main menu for review of test results in the hospital's clinical information system, available at all nursing stations in the hospital.Main Outcome Measure: Hospital LOS.Results: The median LOS for study patients was 7 days. After adjustment for covariates including age, sex, payor, patient care unit, and time trends, the mean LOS in the intervention group was 3.2% shorter than that in the control group (p = 0.022).Conclusion: Computer-generated patient-specific LOS information directed to physicians was associated with a reduction in hospital LOS. n J Am Med Informatics Assoc. 1995;2:58-64.

Health and Clinical Management

“…The findings reported in this article [ 6] add to the growing body of literature showing that computer-generated messages directed to physicians at the. "point of service" -at the time when and at the place where clinical decisions are made-can improve the quality and efficiency of health care.…”

“…Many factors contribute to excessive LOS, and some of these factors cannot be influenced by physicians within the limits of good medical care. However, studies in several medical institutions have shown [6] that computer-generated informational interventions directed at physicians can affect physician behavior. For example, outpatient test ordering and costs were reduced when physicians were shown prior test results, test prices, computergenerated predictions, etc.…”

“…The length of stay (LOS) of patients in hospitals has always been a major factor in formulating the real cost per patient admission [1,6]. Because of recent changes in charging schemes, length-of-stay per admission has become a major issue in hospital cost management in the USA.…”

“…Shea et al [ 6] test the hypothesis that a computer-generated information message directed to physicians would shorten LOS.…”

“…For example, outpatient test ordering and costs were reduced when physicians were shown prior test results, test prices, computergenerated predictions, etc. [6].…”