Re-Justification for Reducing the Length of Hospital Stay Based on Community-Based Appraisal of Functional Recovery of Cerebrovascular Disease Patient

Abstract

Background: Because longer length of hospital stays (LOS) have been recognized to pose a significant economic burden on society, attempts to reduce LOS in acute care hospitals have been implemented to improve the efficiency of care. However, few studies have quantitatively measured the inherent effect of LOS on patient functional recovery in acute care settings. To determine whether a reduction in LOS is justified, we tested whether a longer LOS is associated with the deterioration of functional recovery in patients with nontraumatic cerebrovascular disease (CVD).

Methods: Using Japanese administrative data collected between 2004 and 2008 across 138 acute care hospitals, 19,175 CVD patients with alert consciousness at admission and at discharge were included to remove the sequence of longer LOS caused by consciousness deterioration during hospitalization. The Barthel index (BI) at admission as well as the difference between the BI at admission and discharge were examined. Patient and hospital characteristics, fiscal year, LOS, and total charges (TC; $1 = 100 yen ) were analyzed among three BI improvement categories (deterioration, no change, and improvement). The effects of longer LOS and age on change in BI were determined using mixed linear regression models where study hospitals were handled as a random intercept. To respond to the critique of handling the ordinal variable of BI as the continuous one, logistic regression was employed to assess the association of longer LOS with BI deterioration.

Results: Three point five percent (3.5%), 59.7%, and 36.9% of patients experienced deterioration, no change, and improvement in BI, respectively, and 55.5%, 88.9%, and 15.6% of patients in these respective groups were nearly completely independent at admission. The mean age of deterioration, no change, and improvement in BI was 73.7, 66.5, and 69.5 years, respectively. Longer LOS was significantly associated with less BI improvement, which was more remarkable in patients ≥ 75 years of age. Rehabilitation was not observed to determine the degree of BI improvement, but delayed rehabilitation was observed to predict BI deterioration.

Conclusions: Because a longer LOS was not observed to ameliorate functional recovery, stakeholders should determine the appropriate LOS in acute CVD care and monitor unnecessary hospitalization, especially in the elderly.




J Neurol Res. 2011;1(2):59-68
doi: https://doi.org/10.4021/jnr18e