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

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• 作者：William N. Southern MD ; MS…
• 关键词：Hospital economics ; Incentives ; Outcomes ; Health services
• 刊名：Journal of General Internal Medicine
• 出版年：2015
• 出版时间：June 2015
• 年：2015
• 卷：30
• 期：6
• 页码：712-718
• 全文大小：286 KB
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• 作者单位：William N. Southern MD, MS (1)
  Julia H. Arnsten MD, MPH (2) (3) (4)
  
  1. Department of Medicine, Division of Hospital Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA
  2. Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA
  3. Department of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA
  4. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA
  
• 刊物主题：Internal Medicine;
• 出版者：Springer US
• ISSN：1525-1497

文摘

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-.85), propensity score-matched (OR 1.33, 95?% CI: 1.08-.63), and matched and adjusted analyses (OR 1.36, 95?% CI: 0.98-.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.