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dc.contributor.authorShwartz, Michael
dc.contributor.authorIezzoni, Lisa I.
dc.contributor.authorAsh, Arlene S.
dc.contributor.authorMackiernan, Yevgenia D.
dc.date2022-08-11T08:10:41.000
dc.date.accessioned2022-08-23T17:16:59Z
dc.date.available2022-08-23T17:16:59Z
dc.date.issued1996-10-01
dc.date.submitted2010-07-01
dc.identifier.citationHealth Serv Res. 1996 Oct;31(4):365-85. <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070127/pdf/hsresearch00042-0010.pdf">Link to article on publisher's site</a>
dc.identifier.issn0017-9124 (Linking)
dc.identifier.pmid8885854
dc.identifier.urihttp://hdl.handle.net/20.500.14038/47525
dc.description.abstractDATA SOURCES/STUDY SETTING: Data on admissions to 80 hospitals nationwide in the 1992 MedisGroups Comparative Database. STUDY DESIGN: For each of 14 severity measures, LOS was regressed on patient age/sex, DRG, and severity score. Regressions were performed on trimmed and untrimmed data. R-squared was used to evaluate model performance. For each severity measure for each hospital, we calculated the expected LOS and the z-score, a measure of the deviation of observed from expected LOS. We ranked hospitals by z-scores. DATA EXTRACTION: All patients admitted for initial surgical repair of a hip fracture, defined by DRG, diagnosis, and procedure codes. PRINCIPAL FINDINGS: The 5,664 patients had a mean (s.d.) LOS of 11.9 (8.9) days. Cross-validated R-squared values from the multivariable regressions (trimmed data) ranged from 0.041 (Comorbidity Index) to 0.165 (APR-DRGs). Using untrimmed data, observed average LOS for hospitals ranged from 7.6 to 23.9 days. The 14 severity measures showed excellent agreement in ranking hospitals based on z-scores. No severity measure explained the differences between hospitals with the shortest and longest LOS. CONCLUSIONS: Hospitals differed widely in their mean LOS for hip fracture patients, and severity adjustment did little to explain these differences.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=8885854&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070127/pdf/hsresearch00042-0010.pdf
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectDatabases, Factual
dc.subjectDiagnosis-Related Groups
dc.subjectFemale
dc.subjectHealth Services Research
dc.subjectHip Fractures
dc.subjectHospitals
dc.subjectHumans
dc.subjectLength of Stay
dc.subjectMale
dc.subjectModels, Statistical
dc.subjectOutliers, DRG
dc.subjectPrognosis
dc.subjectRegression Analysis
dc.subject*Severity of Illness Index
dc.subjectUnited States
dc.subjectUtilization Review
dc.subjectBiostatistics
dc.subjectEpidemiology
dc.subjectHealth Services Research
dc.titleDo severity measures explain differences in length of hospital stay? The case of hip fracture
dc.typeJournal Article
dc.source.journaltitleHealth services research
dc.source.volume31
dc.source.issue4
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/qhs_pp/661
dc.identifier.contextkey1378807
html.description.abstract<p>DATA SOURCES/STUDY SETTING: Data on admissions to 80 hospitals nationwide in the 1992 MedisGroups Comparative Database.</p> <p>STUDY DESIGN: For each of 14 severity measures, LOS was regressed on patient age/sex, DRG, and severity score. Regressions were performed on trimmed and untrimmed data. R-squared was used to evaluate model performance. For each severity measure for each hospital, we calculated the expected LOS and the z-score, a measure of the deviation of observed from expected LOS. We ranked hospitals by z-scores.</p> <p>DATA EXTRACTION: All patients admitted for initial surgical repair of a hip fracture, defined by DRG, diagnosis, and procedure codes.</p> <p>PRINCIPAL FINDINGS: The 5,664 patients had a mean (s.d.) LOS of 11.9 (8.9) days. Cross-validated R-squared values from the multivariable regressions (trimmed data) ranged from 0.041 (Comorbidity Index) to 0.165 (APR-DRGs). Using untrimmed data, observed average LOS for hospitals ranged from 7.6 to 23.9 days. The 14 severity measures showed excellent agreement in ranking hospitals based on z-scores. No severity measure explained the differences between hospitals with the shortest and longest LOS.</p> <p>CONCLUSIONS: Hospitals differed widely in their mean LOS for hip fracture patients, and severity adjustment did little to explain these differences.</p>
dc.identifier.submissionpathqhs_pp/661
dc.contributor.departmentDepartment of Quantitative Health Sciences
dc.source.pages365-85


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