An Investigation into Hospital Lengths of Stay and Costly Readmissions

描述（由申请人提供）：对住院时间和昂贵的再入院目标的调查在出院后的短时间内再入院往往是前期护理质量差的指标，但往往是可以预防的。再入院在美国医院中也很普遍，是重要的成本驱动因素。先前尚未探讨的高再入院率的一个潜在解释是索引住院的次优住院时间。如果由于支付者或提供者的经济激励，患者过早出院，那么许多人可能需要在短时间内返回医院接受额外的住院治疗。本项目旨在评估住院时间和再入院之间的关系，并评估潜在的成本节约与改善之间的平衡较长的初始住院时间和减少再入院进行以下目标：目标1：检查住院时间的长短与住院患者再入院的可能性。目的2：评估住院时间和再入院之间的成本权衡。方法主要数据来源于2008年纽约州HCUP住院患者数据库。Logit模型将用于探索指标住院时间与出院后30天内再入院概率之间的关系，控制易感患者特征以及可能与再入院预防相关的其他因素。两部分模型将把概率模型的结果与使用广义线性建模方法估计的再入院成本模型联系起来，以生成预期再入院成本的值。这些将与在最初住院期间延长患者住院时间相关的边际成本估计值进行比较。将对具有相对较高再入院率和/或高成本的选定条件进行亚组分析。 公共卫生相关性：对住院时间和昂贵的再入院相关性的调查。该项目将建立关于住院时间和再入院可能性之间的潜在关系的见解。它还将扩大有关可能可预防的再入院所涉费用的知识。这提供了一个绝佳的机会，通过建立有助于控制医院成本的见解，同时通过减少再入院来提高医院护理质量，从而提高医疗保健服务的价值。

DESCRIPTION (provided by applicant): An Investigation into Hospital Lengths of Stay and Costly Readmissions Objectives Readmissions to the hospital within a short period after discharge are often indicators of poor quality of antecedent care, yet are frequently preventable. Readmissions are also prevalent among U.S. hospitals and are significant cost drivers. A potential explanation for high readmission rates that previously has not been explored is suboptimal length of stay in the index hospitalization. If in response to financial incentives of payers or providers, patients are discharged too soon, then many may need to return to the hospital for additional inpatient care within a short period of time. This project aims to evaluate the relationship between length of stay and readmission, and to assess potential cost savings associated with improving the balance between longer initial hospital stays and reduced readmissions by carrying out the following aims: Aim 1: Examine the extent to which the length of hospital stay is associated with the likelihood of inpatient hospital readmission. Aim 2: Evaluate the cost trade-off between hospital length of stay and readmissions. Methods The primary data source is the 2008 HCUP State Inpatient Database for New York State. Logit models will be used to explore the relationship between length of stay in an index hospitalization and probability of readmission within 30 days of discharge, controlling for predisposing patient characteristics as well as other factors potentially associated with readmission prevention. Two-part models will link the results of the probability models to models of readmission cost estimated using generalized linear modeling approaches, in order to generate values of expected readmission costs. These will be compared with estimated values of the marginal costs associated with keeping patients longer during the initial hospital stay. Subgroup analyses for selected conditions with relatively high readmission rates and/or high costs will be conducted. PUBLIC HEALTH RELEVANCE: An Investigation into Hospital Lengths of Stay and Costly Readmissions Relevance. This project will build insights concerning the potential relationship between length of stay in the hospital and likelihood of hospital readmission. It will also expand knowledge regarding the cost implications of potentially preventable readmissions. This presents an outstanding opportunity to improve value in health care delivery by building insights that will contribute to containing hospital costs simultaneously with improving hospital quality of care through reduced readmissions.