The potential for in-patient mortality reductions to drive cost savings through decreases in hospital length of stay and intensive care unit utilization: a propensity matched cohort analysis

Abstract

Background The economics of healthcare increasingly compels hospitals to accompany quality initiatives with a financial business case. Quality programs are frequently implemented with the aim of identifying clinical deterioration and reducing avoidable mortality. However, low rates of inpatient mortality with a diverse etiology make quantifying cost savings from avoidable mortality reduction challenging. To establish a relationship between mortality and length of stay, a commonly accepted indicator of hospital cost, we evaluated total hospital and intensive care unit length of stay for inpatients who expired compared to similar patients who did not expire during their hospital stay. Methods We conducted a retrospective propensity-matched cohort analysis of hospital inpatients who did and did not expire using de-identified data from 24 hospitals representing six health systems across the United States. In addition to demographic measures, the Rothman Index patient condition score was used to ensure cohorts were matched in physiologic acuity. Multivariable regression models were used to estimate the impact of mortality on the primary outcomes of total and ICU length of stay. Results Matched cohorts of patients who did and did not expire each comprised 6,129 patients. Patients who expired had longer mean overall hospital length of stay (LOS) compared to those who did not (13.3 vs 8.3 days, p < 0.0001) as well as longer mean ICU LOS (7.2 vs 5.7 days, p < 0.0265). Multivariable general linear models identified a 51% increase in predicted LOS and 33% increase in ICU LOS for patients who expired in the hospital. Conclusion As length of stay measures are routinely quantified in financial terms by hospitals, this work suggests it may be possible to translate mortality reductions into length of stay reductions as an inferential step in deriving a financial return on investment for mortality-focused quality of care initiatives.