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Has variation in length of stay in acute hospitals decreased? Analysing trends in the variation in LOS between and within Dutch hospitals.

van de Vijsel AR, Heijink R, Schipper M - BMC Health Serv Res (2015)

Bottom Line: For none of the diagnoses, relative variance decreased on the log scale, suggesting room for further LOS reduction.We found within-hospital variance to be many times greater than between-hospital variance.The results suggest room for efficiency improvement implying lower costs per patient treated.

View Article: PubMed Central - PubMed

Affiliation: National Institute for Public Health and the Environment, Richard Heijink, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands. aart.vandevijsel@xs4all.nl.

ABSTRACT

Background: We aimed to get better insight into the development of the variation in length of stay (LOS) between and within hospitals over time, in order to assess the room for efficiency improvement in hospital care.

Methods: Using Dutch national individual patient-level hospital admission data, we studied LOS for patients in nine groups of diagnoses and procedures between 1995 and 2010. We fitted linear mixed effects models to the log-transformed LOS to disentangle within and between hospital variation and to evaluate trends, adjusted for case-mix.

Results: We found substantial differences between diagnoses and procedures in LOS variation and development over time, supporting our disease-specific approach. For none of the diagnoses, relative variance decreased on the log scale, suggesting room for further LOS reduction. Except for two procedures in the same specialty, LOS of individual hospitals did not correlate between diagnoses/procedures, indicating the absence of a hospital wide policy. We found within-hospital variance to be many times greater than between-hospital variance. This resulted in overlapping confidence intervals across most hospitals for individual hospitals' performances in terms of LOS.

Conclusions: The results suggest room for efficiency improvement implying lower costs per patient treated. It further implies a possibility to raise the number of patients treated using the same capacity or to downsize the capacity. Furthermore, policymakers and health care purchasers should take into account statistical uncertainty when benchmarking LOS between hospitals and identifying inefficient hospitals.

No MeSH data available.


Related in: MedlinePlus

Coefficient of Variation of log-transformed LOS per diagnosis/procedure, between 1995 and 2010 (case-mix corrected on yearly basis)
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Fig1: Coefficient of Variation of log-transformed LOS per diagnosis/procedure, between 1995 and 2010 (case-mix corrected on yearly basis)

Mentions: FigureĀ 1 shows the coefficient of variation (CV) of the log-transformed LOS. CV is a measure of relative variation (ratio of standard deviation and mean). Up to 2001, the CV increased for all diagnoses and procedures, whilst after 2001 the CV was stable for CVA, FEMUR, HIP and KNEE. Thus, even though total variance decreased for the latter four groups after 2001, the CV remained stable because of a steep decline of their mean LOS. For the other five diagnoses and procedures the CV continued to increase. The increase of the CV was largest for AMIplus and CHOL. The latter is caused by a large decrease of the mean LOS for both diseases, while for AMIplus a substantial increase in total variance also affected the increase of the CV.Fig. 1


Has variation in length of stay in acute hospitals decreased? Analysing trends in the variation in LOS between and within Dutch hospitals.

van de Vijsel AR, Heijink R, Schipper M - BMC Health Serv Res (2015)

Coefficient of Variation of log-transformed LOS per diagnosis/procedure, between 1995 and 2010 (case-mix corrected on yearly basis)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4590267&req=5

Fig1: Coefficient of Variation of log-transformed LOS per diagnosis/procedure, between 1995 and 2010 (case-mix corrected on yearly basis)
Mentions: FigureĀ 1 shows the coefficient of variation (CV) of the log-transformed LOS. CV is a measure of relative variation (ratio of standard deviation and mean). Up to 2001, the CV increased for all diagnoses and procedures, whilst after 2001 the CV was stable for CVA, FEMUR, HIP and KNEE. Thus, even though total variance decreased for the latter four groups after 2001, the CV remained stable because of a steep decline of their mean LOS. For the other five diagnoses and procedures the CV continued to increase. The increase of the CV was largest for AMIplus and CHOL. The latter is caused by a large decrease of the mean LOS for both diseases, while for AMIplus a substantial increase in total variance also affected the increase of the CV.Fig. 1

Bottom Line: For none of the diagnoses, relative variance decreased on the log scale, suggesting room for further LOS reduction.We found within-hospital variance to be many times greater than between-hospital variance.The results suggest room for efficiency improvement implying lower costs per patient treated.

View Article: PubMed Central - PubMed

Affiliation: National Institute for Public Health and the Environment, Richard Heijink, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands. aart.vandevijsel@xs4all.nl.

ABSTRACT

Background: We aimed to get better insight into the development of the variation in length of stay (LOS) between and within hospitals over time, in order to assess the room for efficiency improvement in hospital care.

Methods: Using Dutch national individual patient-level hospital admission data, we studied LOS for patients in nine groups of diagnoses and procedures between 1995 and 2010. We fitted linear mixed effects models to the log-transformed LOS to disentangle within and between hospital variation and to evaluate trends, adjusted for case-mix.

Results: We found substantial differences between diagnoses and procedures in LOS variation and development over time, supporting our disease-specific approach. For none of the diagnoses, relative variance decreased on the log scale, suggesting room for further LOS reduction. Except for two procedures in the same specialty, LOS of individual hospitals did not correlate between diagnoses/procedures, indicating the absence of a hospital wide policy. We found within-hospital variance to be many times greater than between-hospital variance. This resulted in overlapping confidence intervals across most hospitals for individual hospitals' performances in terms of LOS.

Conclusions: The results suggest room for efficiency improvement implying lower costs per patient treated. It further implies a possibility to raise the number of patients treated using the same capacity or to downsize the capacity. Furthermore, policymakers and health care purchasers should take into account statistical uncertainty when benchmarking LOS between hospitals and identifying inefficient hospitals.

No MeSH data available.


Related in: MedlinePlus