Dataset Information

Variation in hospital length of stay: do physicians adapt their length of stay decisions to what is usual in the hospital where they work?

ABSTRACT:

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 (1999, 2000, 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 (p<.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.

SUBMITTER: de Jong JD

PROVIDER: S-EPMC1702523 | biostudies-literature | 2006 Apr

REPOSITORIES: biostudies-literature

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Publications

Variation in hospital length of stay: do physicians adapt their length of stay decisions to what is usual in the hospital where they work?

de Jong Judith D JD Westert Gert P GP Lagoe Ronald R Groenewegen Peter P PP

Health services research 20060401 2

<h4>Objective</h4>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.<h4>Data sources</h4>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 ambula ...[more]

PMID: 16584454

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Project description:BackgroundWithin the scope of value-based health care, this study aimed to analyze Dutch hospital performance in terms of length of hospital stay after esophageal cancer surgery and its association with 30-day readmission rates. Since both parameters are influenced by the occurrence of complications, this study only included patients with an uneventful recovery after esophagectomy.MethodsAll patients registered in the Dutch Upper Gastrointestinal Cancer Audit (DUCA) who underwent a potentially curative esophagectomy between 2015 and 2018 were considered for inclusion. Patients were excluded in case of an intraoperative/post-operative complication, readmission to the intensive care unit, or any re-intervention. Length of hospital stay was dichotomized around the national median into 'short admissions' and 'long admissions'. Hospital variation was evaluated using a case-mix-corrected funnel plot based on multivariable logistic regression analyses. Association of length of hospital stay with 30-day readmission rates was investigated using the χ2-statistic.ResultsA total of 1007 patients was included. National median length of hospital stay was 9 days, ranging from 6.5 to 12.5 days among 17 hospitals. The percentage of 'short admissions' per hospital ranged from 7.7 to 93.5%. After correction for case-mix variables, 3 hospitals had significantly higher 'short admission' rates and 4 hospitals had significantly lower 'short admission' rates. Overall, 6.2% [hospital variation (0.0-13.2%)] of patients were readmitted. Hospital 30-day readmission rates were not significantly different between patients with a short length of hospital stay and those with a long length of hospital stay (5.5% versus 7.6%; p = 0.19).ConclusionsBased on these nationwide audit data, median length of hospital stay after an uncomplicated esophagectomy was 9 days ranging from 6.5 to 12.5 days among Dutch hospitals. There was no association between length of hospital stay and readmission rates. Nationwide improvement might lead to a substantial reduction of hospital costs.

Project description:Administrative data accumulating daily from hospitals would provide new possibilities to assess work shifts and patient care. We aimed to investigate associations of work unit level average work shift length and length of patient in-hospital stay, and to examine the role of nurse-patient-ratio, year, night work, age, work units and working hours at the work units for these estimations. The data for this study were based on combined administrative day-to-day patient and pay-roll based objective working hour data of employees of one hospital district in Finland for 2013-2019. Three patient measures were calculated: the overall length of in-hospital stay, the length of in-hospital stay before a medical procedure and the length of in-hospital stay after a medical procedure. A Generalized Linear Mixed Model (GLMM) with multivariate normal random effects was used with Penalized Quasi-Likelihood for relative risk ratios (RR) with 95% confidence intervals (CI). The results showed that compared to <8 hours work shifts, 8-10 hours work shifts were associated with an increased likelihood of overall length of in-hospital stay (RR 1.16, 95%CI 1.15, 1.16), and the length of in-hospital stay after a medical procedure (RR 1.28, 95%CI 1.27, 1.30). The >10 hours work shifts were associated with a decreased likelihood of the overall length of in-hospital stay (RR 0.94, 95% CI 0.94, 0.95) and length of in-hospital stay after a medical procedure among all occupations (RR 0.94, 95% CI 0.92, 0.97). These associations retained the magnitude and direction in the models additionally adjusted for work, employee, and patient characteristics, and the associations were weaker for nurses than among all occupations. To conclude, compared with the standard work shifts, 8-10 hours work shifts seem to be associated with longer, and >10 hours work shifts with shorter length of in-hospital stay. Administrative data provides feasible possibilities to investigate working hours and length of in-hospital stay.

Dataset Information

Variation in hospital length of stay: do physicians adapt their length of stay decisions to what is usual in the hospital where they work?

Objective

Data sources

Study design

Principal findings

Conclusion

Publications

Variation in hospital length of stay: do physicians adapt their length of stay decisions to what is usual in the hospital where they work?

Similar Datasets

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