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    Does severity explain differences in hospital length of stay for pneumonia patients

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    Authors
    Iezzoni, Lisa I.
    Shwartz, Michael
    Ash, Arlene S.
    Mackiernan, Yevgenia D.
    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    1996-03-08
    Keywords
    Centers for Medicare and Medicaid Services (U.S.)
    Diagnosis-Related Groups
    Forecasting
    Health Care Surveys
    Health Services Research
    Hospitals
    Humans
    Length of Stay
    Models, Theoretical
    Outcome Assessment (Health Care)
    Pneumonia
    Regression Analysis
    *Severity of Illness Index
    United States
    Biostatistics
    Epidemiology
    Health Services Research
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    Link to Full Text
    http://jhsrp.rsmjournals.com/misc/vol1.dtl
    Abstract
    OBJECTIVES: In the USA, the role of patient severity in determining hospital resource use has been questioned since Medicare adopted prospective hospital payment based on diagnosis-related groups (DRGs). Exactly how to measure severity, however, remains unclear. We examined whether assessments of severity-adjusted hospital lengths of stay (LOS) varied when different measures were used for severity adjustment. METHODS: The complete study sample included 18,016 patients receiving medical treatment for pneumonia at 105 acute care hospitals. We studied 11 severity measures, nine based on patient demographic and diagnosis and procedure code information and two derived from clinical findings from the medical record. For each severity measure, LOS was regressed on patient age, sex, DRG, and severity score. Analyses were performed on trimmed and untrimmed data. Trimming eliminated cases with LOS more than three standard deviations from the mean on a log scale. RESULTS: The trimmed data set contained 17,976 admissions with a mean (S.D.) LOS of 8.9 (6.1) days. Average LOS ranged from 5.0-11.8 days among the 105 hospitals. Using trimmed data, the 11 severity measures produced R-squared values ranging from 0.098-0.169 for explaining LOS for individual patients. Across all severity measures, predicted average hospital LOS varied much less than the observed LOS, with predicted mean hospital LOS ranging from about 8.4-9.8 days. DISCUSSION: No severity measure explained the two-fold differences among hospitals in average LOS. Other patient characteristics, practice patterns, or institutional factors may cause the wide differences across hospitals in LOS.
    Source
    J Health Serv Res Policy. 1996 Apr;1(2):65-76. Link to article on publisher's site
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/47515
    PubMed ID
    10180852
    Related Resources
    Link to Article in PubMed
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    Population and Quantitative Health Sciences Publications

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