Increased Risk of Mortality among Patients Cared for by Physicians with Short Length-of-Stay Tendencies

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Abstract

Background: Since the introduction of the prospective payment system in 1983, U.S. hospitals have been financially incentivized to reduce inpatient length of stay, and average length of stay has shortened dramatically. Objective: The purpose of this study was to determine whether short length of stay is associated with worse patient outcomes. Design: We used a quasi-experimental design to compare the outcomes of admissions assigned to physicians with short versus long length-of-stay tendencies. We used each physician’s mean length of stay to define their length of stay tendency. We then compared the outcomes of admissions assigned to physicians with short versus long length-of-stay tendencies in propensity score-matched and adjusted analyses using mixed-effects and conditional logistic regression models. Patients: The study included all admissions for 10 common diagnoses among patients admitted to the medical teaching service of an urban academic hospital from 7/1/2002 through 6/30/2008. Main Measure: The primary outcome was 30-day mortality. Results: We examined 12,341 admissions among 79 physicians. After propensity score matching, admission groups were similar with respect to all demographic and clinical characteristics. Admissions of patients receiving care from short length-of-stay physicians were associated with significantly increased risk of 30-day mortality in adjusted (OR 1.43, 95 % CI: 1.11–1.85), propensity score-matched (OR 1.33, 95 % CI: 1.08–1.63), and matched and adjusted analyses (OR 1.36, 95 % CI: 0.98–1.90). Conclusions: Policies that incentivize short length of stay may lead to worse patient outcomes. The financial benefits of shortening inpatient length of stay should be weighed against the potential harm to patients.

Original languageEnglish (US)
Pages (from-to)712-718
Number of pages7
JournalJournal of General Internal Medicine
Volume30
Issue number6
DOIs
StatePublished - Jan 24 2015

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Length of Stay
Physicians
Mortality
Propensity Score
Inpatients
Logistic Models
Prospective Payment System
Patient Harm
Urban Hospitals
Patient Care
Teaching
Research Design
Demography

Keywords

  • Health services
  • Hospital economics
  • Incentives
  • Outcomes

ASJC Scopus subject areas

  • Internal Medicine

Cite this

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title = "Increased Risk of Mortality among Patients Cared for by Physicians with Short Length-of-Stay Tendencies",
abstract = "Background: Since the introduction of the prospective payment system in 1983, U.S. hospitals have been financially incentivized to reduce inpatient length of stay, and average length of stay has shortened dramatically. Objective: The purpose of this study was to determine whether short length of stay is associated with worse patient outcomes. Design: We used a quasi-experimental design to compare the outcomes of admissions assigned to physicians with short versus long length-of-stay tendencies. We used each physician’s mean length of stay to define their length of stay tendency. We then compared the outcomes of admissions assigned to physicians with short versus long length-of-stay tendencies in propensity score-matched and adjusted analyses using mixed-effects and conditional logistic regression models. Patients: The study included all admissions for 10 common diagnoses among patients admitted to the medical teaching service of an urban academic hospital from 7/1/2002 through 6/30/2008. Main Measure: The primary outcome was 30-day mortality. Results: We examined 12,341 admissions among 79 physicians. After propensity score matching, admission groups were similar with respect to all demographic and clinical characteristics. Admissions of patients receiving care from short length-of-stay physicians were associated with significantly increased risk of 30-day mortality in adjusted (OR 1.43, 95 {\%} CI: 1.11–1.85), propensity score-matched (OR 1.33, 95 {\%} CI: 1.08–1.63), and matched and adjusted analyses (OR 1.36, 95 {\%} CI: 0.98–1.90). Conclusions: Policies that incentivize short length of stay may lead to worse patient outcomes. The financial benefits of shortening inpatient length of stay should be weighed against the potential harm to patients.",
keywords = "Health services, Hospital economics, Incentives, Outcomes",
author = "Southern, {William N.} and Arnsten, {Julia H.}",
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AU - Arnsten, Julia H.

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N2 - Background: Since the introduction of the prospective payment system in 1983, U.S. hospitals have been financially incentivized to reduce inpatient length of stay, and average length of stay has shortened dramatically. Objective: The purpose of this study was to determine whether short length of stay is associated with worse patient outcomes. Design: We used a quasi-experimental design to compare the outcomes of admissions assigned to physicians with short versus long length-of-stay tendencies. We used each physician’s mean length of stay to define their length of stay tendency. We then compared the outcomes of admissions assigned to physicians with short versus long length-of-stay tendencies in propensity score-matched and adjusted analyses using mixed-effects and conditional logistic regression models. Patients: The study included all admissions for 10 common diagnoses among patients admitted to the medical teaching service of an urban academic hospital from 7/1/2002 through 6/30/2008. Main Measure: The primary outcome was 30-day mortality. Results: We examined 12,341 admissions among 79 physicians. After propensity score matching, admission groups were similar with respect to all demographic and clinical characteristics. Admissions of patients receiving care from short length-of-stay physicians were associated with significantly increased risk of 30-day mortality in adjusted (OR 1.43, 95 % CI: 1.11–1.85), propensity score-matched (OR 1.33, 95 % CI: 1.08–1.63), and matched and adjusted analyses (OR 1.36, 95 % CI: 0.98–1.90). Conclusions: Policies that incentivize short length of stay may lead to worse patient outcomes. The financial benefits of shortening inpatient length of stay should be weighed against the potential harm to patients.

AB - Background: Since the introduction of the prospective payment system in 1983, U.S. hospitals have been financially incentivized to reduce inpatient length of stay, and average length of stay has shortened dramatically. Objective: The purpose of this study was to determine whether short length of stay is associated with worse patient outcomes. Design: We used a quasi-experimental design to compare the outcomes of admissions assigned to physicians with short versus long length-of-stay tendencies. We used each physician’s mean length of stay to define their length of stay tendency. We then compared the outcomes of admissions assigned to physicians with short versus long length-of-stay tendencies in propensity score-matched and adjusted analyses using mixed-effects and conditional logistic regression models. Patients: The study included all admissions for 10 common diagnoses among patients admitted to the medical teaching service of an urban academic hospital from 7/1/2002 through 6/30/2008. Main Measure: The primary outcome was 30-day mortality. Results: We examined 12,341 admissions among 79 physicians. After propensity score matching, admission groups were similar with respect to all demographic and clinical characteristics. Admissions of patients receiving care from short length-of-stay physicians were associated with significantly increased risk of 30-day mortality in adjusted (OR 1.43, 95 % CI: 1.11–1.85), propensity score-matched (OR 1.33, 95 % CI: 1.08–1.63), and matched and adjusted analyses (OR 1.36, 95 % CI: 0.98–1.90). Conclusions: Policies that incentivize short length of stay may lead to worse patient outcomes. The financial benefits of shortening inpatient length of stay should be weighed against the potential harm to patients.

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