length of stay quality measure

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P<.05 was considered statistically significant.13,15 Analyses were carried out using SAS statistical software (version 9; SAS Institute, Cary, NC).14. The patients were assessed as ready to go and the physicians were ready to write the discharge orders, but the consultant had not put a final opinion on the medical record, there was some nursing issue to be done, the discharge supplies were not ready, or there was no bed available in a rehabilitation facility or a nursing facility. Mean LOS was 9.6 days. Clinical factors were defined as body region injured, Injury Severity Score, and Revised Trauma Score. Your multivariate logistic regression shows a number of these variables as being individually important, but I cannot imagine that many of these are not related to each other. My question is: How can we take these data and turn them around and create a national forum to really increase access to rehabilitation, which is one of the frontiers of trauma systems that is totally undeveloped. Variables were identified as significant using a .05 α level, and only these were included in a stepwise method to determine a final model. Rather, we suggest these data bring into question whether LOS should be considered a process measure or an outcome measure. Despite certain limitations (lack of clinical detail, coding variations, time lags), quality experts regard administrative data as a reliable and usable source for the purpose of assessing hospital quality. +, positive correlation. The current data demonstrate that discharge destination had the strongest association with extended LOS, with odds ratios ranging from 1.15 to 3.83 for discharge destinations other than home.  GKim  III The financial impact of delayed discharge at a level I trauma center.Â, Collins  KJWeigelt Accepted for Publication: December 31, 2006. Clearly, age, physiologic status, and body region injured are also important. Privacy Policy| Model of the correlation between Quality of care, Length of stay and patient satisfaction. '|ⲻg��o�U��SO�b�ir�����oLK��$U�1��  RWRoberton  N In hospitalized injured patients, LOS in an acute care hospital is clearly affected by the need for rehabilitation or long-term care. Adjustment for clinical factors, or risk adjustment, is also inadequate. Some are relatively easy to measure, including mortality, perioperative myocardial infarction, and surgical site infection. A high number could indicate a problem with the facility’s prescription ordering system. Can a single statistic serve as a valid indicator of quality and efficiency? Donald E. Low, MD, Seattle: Many of the comparisons in which we see LOS used as the most relevant factor have to do with the evolution from open to minimally invasive and even interventional types of procedures.  WM Relationship between clinical performance measures and outcomes among patients receiving long-term hemodialysis.Â, Liu And that was not even because of some of these nonclinical factors.  WHKhuri Therefore, when a patient is well enough to receive care outside of the hospital, they should be discharged and managed in a less costly way. �� 5h�A��6C�̐i�sF�i���{��`��1}wۍø(g��G`��Θ0�cS�OX������-���ȥ����.�J�.�:�� ���S��U�m���yQw�m!��"�����0P�`:`‚Q���/%N*�)O�Y�/�:IG�:����|�J����0�6I�p��,]��8�S���9.p�+\c��Xa�/�����fk�W��kb�D�O6C�-�;�ܵ����dQA��A��q\|�t� Something that can, and does, vary. Trauma patients treated at hospitals participating in data submission to the National Trauma Data Bank. Inpatient Encounters ending during the measurement period with Length of Stay (Discharge Date minus Admission Date) less than or equal to 120 days, and preceded within an hour by an emergency department visit at the same physical facility Measure Steward: Centers for Medicare & Medicaid Services (CMS) Measure Scoring Length of stay. Length of stay should be used as a process measure rather than an outcome measure to truly improve the quality of care that we give. I have 2 questions: Have you looked at the direct variable costs in your facility? Comorbid conditions, clearly shown to affect LOS in hospitalized injured patients, were not considered in the model because of the large amount of missing data and quality of this field in the version used. Patients  Should organizations that purport to measure quality of care abandon LOS as an indicator of effective and efficient care? What I would like to see is LOS used intelligently and to work with administrators rather than having them spend inordinate amounts of personnel time and statistical time fudging the statistics to make LOS look good.  JWedderburn Dr Brasel and her colleagues could have entitled this paper “Lies, Damn Lies, and Statistics.” I have several questions. Scott R. Petersen, MD, Phoenix, Ariz: Hospital administrators are constantly looking at LOS and, subsequently, direct variable costs. Length of Stay: An Appropriate Quality Measure?  et al.  Discharge disposition from acute care after traumatic brain injury: the effect of insurance type.Â, Schoetz I do not think we are going to be able to throw out LOS.  JAChristians Length of stay was longer for patients discharged to a nursing home (14.2 days) or rehabilitation facility (11.5 days) compared with those discharged to any other facility (9.6 days).  LB The value of process measures in evaluating an evidence-based guideline.Â,  A resource from the Institute for Healthcare Improvement.Â, Spertus Seventy-four percent of the patients were white, 17% were black, 6% were Hispanic, 1% were Asian/Pacific Islander, and 0.5% were Native American or Native Alaskan. We analyzed administrative data from the Global Comparators Project from 26 hospitals on patients discharged … h��Xko۸�+���"ᛔ.�w�M��Ӧ� ��hkK�-����{����#m�]�9�g�)��x$����(m$b��"� .�dB�I���6���A�XF�F�XE14�XG�(чc��-)R�`��ԕT&��B�s�#�$5�HY.”*F�D?�a�Lt�5)K,H�b#�B�E�K�O���GF)��<2�B=���).#�z�Ud&��7��xt�v������i��n1��v���G?~����6��5;���4��Ay�\����,7ۚǑj[h�Po;�Y�WI3�����\�ʝ�+���t��Y���a:����C6�G��)���?����g�m:�zTN"��'d�;Wˣ~������N5���^:��6�:��*-/�w7���|P�d�;I��(�� ������|�W�M���������[G�zӁ��(V����c��ݗ�3;X}� ��0��b'�p1;,�rw�x��N��p�Wp�S������V�ӥ�w�ȳ�?�]�}u8+g�tk�ް�e:���n�#��������&d�$�ń}���5�ouY��Ykp�`L6��{���t�?�.oӺ��s̑�]�� The organization embraced the … •Variables are what are measured. The type of payment was categorized into the following 5 groups: commercial, Medicaid, Medicare, uninsured, and other. Finally, based on your analysis, is LOS a meaningless parameter of quality measurement? This relationship is best illustrated with process measures. Using LOS as a process measure rather than a benchmark outcome measure enables an individual trauma center to investigate and address all of these potential reasons. Based on these data, it is tempting to suggest that LOS should not be used as a quality indicator. Total patient days can be calculated by adding the length of stay of all patients during the period under calculation. Fig. Efforts to measure ED quality are in their infancy, focusing on a small set of conditions and timeliness measures, such as waiting times and length-of-stay. the Average Length Of Stay (ALOS) for patients under Hospitalist care exceed the benchmarks for large community non-teaching hospitals. •They represent the properties of an object that we are interested in measuring. STS continues to develop and maintain quality performance measures in the areas of adult cardiac, general thoracic, and congenital heart surgery. Some of these factors include discharge destination, the presence or absence of family support, payer status, and the availability of rehabilitation or long-term care facilities.  D Impact of pre-trauma center care on length of stay and hospital charges.Â, Holloway  W The effect of complications on length of stay.Â, Case  et al.  Health-related quality of life and postoperative length of stay for patients with colorectal cancer.Â, Thomas sign up for alerts, and more, to access your subscriptions, sign up for alerts, and more, to download free article PDFs, sign up for alerts, customize your interests, and more, to make a comment, download free article PDFs, sign up for alerts and more, Archives of Neurology & Psychiatry (1919-1959), FDA Approval and Regulation of Pharmaceuticals, 1983-2018, Global Burden of Skin Diseases, 1990-2017, Health Care Spending in the US and Other High-Income Countries, Life Expectancy and Mortality Rates in the United States, 1959-2017, Medical Marketing in the United States, 1997-2016, Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter, US Burden of Cardiovascular Disease, 1990-2016, US Burden of Neurological Disease, 1990-2017, Waste in the US Health Care System: Estimated Costs and Potential for Savings, Register for email alerts with links to free full-text articles.  EACleary If LOS is used as a quality measure for injured patients, adjustment for these factors is necessary. Quality | Quality improvement. Compared with patients discharged to home, the odds ratio for an extended LOS for patients discharged to another hospital, rehabilitation facility, or nursing home was 2.23, 3.74, and 3.83, respectively. Retrospective database analysis. By continuing to use our site, or clicking "Continue," you are agreeing to our, 2020 American Medical Association. In your database, did you look at high-volume trauma centers, different levels of trauma centers, and how that influenced LOS? Complication Rate:The percentage of patients who develop complications (typically surgical complications) as a result of care. © 2020 American Medical Association. 6�nlb�X��4Du$[����9�H�֗\{��)� xX�I endstream endobj 410 0 obj <>stream  SE What is the UHC using as risk adjustments in a trauma population for LOS? The National Trauma Data Bank was queried for all patients older than 18 years with an LOS longer than 48 hours and complete demographic information including age, sex, and race/ethnicity; nonclinical factors including payment type (commercial, Medicaid, Medicare, uninsured, and other) and discharge destination (home, rehabilitation facility, nursing home, and other); and clinical information (body region injured, Injury Severity Score, and Revised Trauma Score).  ML Records were also excluded if any of the primary variables of interest were missing. Subgroup analysis investigated the effect of missing variables; risk estimates did not change significantly and, therefore, data imputation for missing variables was not performed.  KE Using clinical practice analysis to improve care.Â, Guru �� Length of stay (LOS) has been suggested as a meaningful outcome measure that is a potential target for quality improvement activities.1-5 The American College of Surgeons Committee on Trauma uses LOS as an example outcome measure for a performance improvement program.6 Although the influence of many clinical factors on LOS is both intuitive and supported by data, studies from medical and elective surgical patients confirm the additional importance of nonclinical factors.7-12 One of these factors is insurance or payer status. These realities of rehabilitation and skilled subacute care needs suggest that using LOS as a process measure may be helpful to a trauma system of care.  JTemkin  M All other things being equal, a shorter stay will reduce the cost per discharge and shift care from inpatient to less expensive post-acute settings. Dr Brasel: I would say, probably not.  JElbel  SSarosi  A Quality assessment and assurance: unity of purpose, diversity of means.Â, Crombie Correspondence: Karen J. Brasel, MD, MPH, Department of Surgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226 (kbrasel@mcw.edu). %PDF-1.7 %���� Structure is simply the infrastructure of the health care system, which includes the individuals, the equipment, and the physical plant. Conclusions  0j�M��ٛ�&HcV�wAb'@���?��x��Ab�w�f�j�F��{��M���CG#Z�Υ����[$ԅ ^ u�`���u����:}o�%��ԩ=� �zm� Although demographic and clinical information are known to affect hospital length of stay (LOS), we hypothesized that LOS after traumatic injury would be significantly influenced by nonclinical factors.  RV Defining excess resource utilization and identifying associated factors for trauma victims.Â,  The best medical evidence for the best care management.Â,  Wisconsin Collaborative for Healthcare Quality Web site.Â, Englert In multivariate analysis, factors significantly associated with extended LOS included age, sex, race/ethnicity, insurance status, discharge destination, and Revised Trauma Score.  LMYaezel We aimed to disentangle the correlations between these interrelated measures and propose a new way of combining them to evaluate the quality of hospital care. hospitals to improve length of stay efficiency • evaluates the effectiveness of targeted programs and better practice guidance. However, the large number of hospitals from different regions of the United States that do contribute allow many possible regional influences to be overcome. 1.  GMFremes The NHS has, for a long time, focused on attempting to reduce patient length of stay in hospital. Clinical factors alone may capture only 27% of the variation in extended LOS.1 Most risk-adjustment models do not include adjustment for the important nonclinical factors that affect LOS.  JHenderson Dr Brasel: We did not look at level of trauma center. David B. Hoyt, MD, Orange, Calif: Embedded in your data is this problem with access to rehabilitation. Ninety percent of direct variable cost is directly related to LOS. Results of the analysis of variance are given in Table 1; results of the generalized linear model analysis are given in Table 2. Statistical analysis: Lim and Nirula. Drafting of the manuscript: Brasel, Lim, and Nirula. 266 Emergency Department Length of Stay as a Quality Measure: Will There Be Unintended Consequences for Safety-Net Emergency Departments?. We hypothesized that nonclinical factors, specifically payer status, would similarly affect LOS in injured patients.  CWeigelt Dr Brasel: I am not sure I have a short or a simple answer to that question, but I do think it is important. Analysis and interpretation of data: Brasel, Lim, and Nirula. Results  Longer than necessary LOS results in excess costs of $1,393,850 annually. We included mechanism of injury, blunt vs penetrating trauma, in early analyses. Overall survival was 97%. Implementation of the weekly long length of stay patient reviews as set out in ‘reducing long length of stays’ 14 May 2019 Shared learning. Author Contributions:Study concept and design: Brasel, Lim, Nirula, and Weigelt. Mean LOS for patients with Medicaid (11.3 days) was significantly longer than for patients with commercial insurance and uninsured patients (each 9.3 days) and patients with Medicare (8.8 days). Utilization of hospital services or procedures as measured by the hospital discharge rate or average length of stay. That would be interesting to do. For example, adherence to a guideline for management of patients with splenic injuries improved outcome, measured as splenic salvage rate.22 Process measures are also used in the Institute for Healthcare Improvement 100 000 Lives initiative23 in an effort to reduce catheter-related bloodstream infection, ventilator-associated pneumonia, surgical site infection, in-hospital cardiopulmonary arrest, death after myocardial infarction, and adverse drug events. Outcomes are, simply put, results. �)g�rZ�"*g���*4N�")��ɠ���\Td�Ri�F��� �I� Acquisition of data: Brasel. Length of stay was longer for patients discharged to a nursing home (14.2 days) or rehabilitation facility (11.5 days) compared with those discharged to any other facility (9.6 days). Many current quality improvement efforts focus on measuring structure and process because these are usually easier to measure than outcomes.20,21 The relationship of structure and process to outcomes can be direct or indirect. It comes down to realizing that hospital care usually costs more for patients and the organization than care in outpatient settings.  GJMaier What are you tracking now in your own facility insofar as LOS?  JrRue Hypothesis  Study supervision: Brasel and Weigelt. ʗ�nibl�T�o������p���49�B-\��(�Y49"ڥL�;P�joD�W�kMX���!u��>-ݏ�Y�ރ � �W�� ��=�%n�~,����5~�i[�b�B~���.~__~8�p���|� �w~�*w��E��c��N�.������n��t�&m�z��W���]��EX��S��r}�o�����APz H~5�5^�g$B����F�ח����:�� Dr Brasel: All of the factors that the UHC adjusts for are clinical, unlike the Hospital Efficiency Index, which includes some nonclinical adjustment.  HT Beyond health outcomes: the advantages of measuring process.Â, Brook ADDRESSING BARRIERS TO REDUCING LENGTH OF STAY IN HOSPITAL The analysis included 313 144 medical records. There is hardly any research on how patients in general appreciate the actual length of a hospital stay. The National Trauma Data Bank was queried for all patients older than 18 years with an LOS longer than 48 hours and complete demographic information including age, sex, and race/ethnicity; nonclinical factors including payment type (commercial, Medicaid, Medicare, uninsured, and other) and discharge destination (home, rehabilitation facility, nursing home, and other); and clinical information (body region injured, Injury Severity Score, and Revised Trauma Score). Quality medical care has become the primary focus in US health care since the 2000 report from the Institute of Medicine.16 Organizationally, performance improvement is the cornerstone on which advances and increases in quality are based. Equity Measures While not associated with any particular IOM domain, descriptive measures can convey the hospital’s capacity for providing quality of care and service. While unadjusted LOS may not be a valid outcome measure, it may have value as a process measure for many trauma programs. h�22�P0P����+�-�6 2��]��b�� U�� endstream endobj 407 0 obj <>stream =mE�;��]f7���J� Length of stay (LOS) has been suggested as a meaningful outcome measure that is a potential target for quality improvement activities. 1-5 The American College of Surgeons Committee on Trauma uses LOS as an example outcome measure for a performance improvement program. Measure Category: Clinical Outcomes Quality Domain: Patient Safety; Efficiency Current Findings in the Literature: Patients may  et al.  Impact of age on clinical care pathway length of stay after complex head and neck resection.Â, Nelder to download free article PDFs,  AABroyles The discussions that follow this article are based on the originally submitted manuscript and not the revised manuscript. These quality control measures relate to reducing medical errors and protecting patients. "#|��Z�0�v)�Ė�?�KV�B�q�q�t������~���&��/�-��]�']�_��/�[�ܜu"�.�/���xs�tAV�ޭ =E/�RRI�n��L�K���Q�@$� ���U�� �j�1.x�Q2D�!G@_�(t��@���G���1����&��@���7K(����>�@�"�I����F%K��r�>dM��������?�������k���E�� O�F�'r����'��]�3=����J�}_"ԗ$������9z�Э Overall average length of stay decreased from 19 days to 7.5 days Average acute length of stay decreased from 6 days to 4 days Average ALC length of stay decreased from 25 days to 22 days There was a 48% improvement in assigning the expected date of discharge (from 50% to 98%) There was a 66% improvement for meeting the expected date of Length of Stay This measure allows organizations to systematically assess the impact of implementing health information technology (health IT) with the intent to decrease inpatient length of stay (LOS). Main Outcome Measures   et al. Canadian CABG Surgery Quality Indicator Consensus Panel, The identification and development of Canadian coronary artery bypass graft surgery quality indicators.Â, American College of Surgeons Committee on Trauma,Â, Khaliq Analysis of variance was use for continuous variable and a χ2 test was used for categorical variables. It is so easy to measure and is such a part of the administrative culture. 2. What is a variable? Mean ± SD age of patients was 48.2 ± 21.1 years; 62.3% were men.  C Outpatient mastectomy: clinical, payer, and geographic influences.Â, Kagan Mean ± SD LOS was 9.6 ± 12.8 days. Your article has highlighted that LOS and indirectly controllable costs are not necessarily a provider-only outcome but a process of care.  SHChalian Ni���K*$��T,�v� m�*���/i�P���'�c.  EJMorris Charges. hެTmo�@�+���"��\� Transfer agreements for rehabilitation and LTACF care could be incorporated into a trauma center's overall care plan.  MALambert Descriptive statistics were used to summarize the data. While acute care is provided without concern for insurance status in most cases, rehabilitation or placement in a long-term acute care facility (LTACF) is done only after an assessment of payment has been made. It did not turn out to be independently significant, although, as you might imagine, patients who are injured through blunt mechanisms are significantly different with respect to some of those nonclinical factors from patients who are injured via penetrating mechanisms. Our website uses cookies to enhance your experience.  WA The application of statistics as an aid in maintaining quality of a manufactured product.Â, Donabedian Trauma patients treated at hospitals participating in data submission to the National Trauma Data Bank. Mean ± SD Injury Severity Score was 12.3 ± 9.3. . Early results suggest that compliance with the identified process measures improves the targeted outcomes.23,24 Other studies have not confirmed that standardized process implementation will have significant effect on outcomes.25 While process measures may correlate directly with desirable outcomes, it is not clear that all process or outcome measures will monitor or measure what is intended to be measured.24-26. For example, the percentage of uninsured patients, 16% in your study, seems small for a trauma population. ����a�(�]�b�E�gQh�Xd[��6�j|�x�Z?m��P�ͽ��B+��MNq���Kԑ�ˬ(����!��|�o�Z�8(F���oc�,n�?~R�"����w?�x�l�n�Ϧ�#�����:�!���eU���C�c�l���vȎ�k������3�;�̆�g�%������yh����3�Q�c��M��v��W�Ȟ�?̏n������iE_ky;��:�*َ��lD�ހ�-6�x�tv�Nj����W�#$I�"��:�w�a:Y~�^}�vC��IZq�,��m��l�5�Ǭ�>R���._��湿�����"qv�rH� R�{�a@���P��I(-���A��K'�$��׬������N,L8C �1]jD\�$}��pd$����. Because the analysis of variance showed differences in LOS by group, generalized linear models were created to examine the association of demographic, clinical, and nonclinical factors, as well as the interaction term of race/ethnicity × payer status, with an LOS greater than the mean. Examples include the use of perioperative β-blockers, the timeliness of perioperative antibiotic administration, and the presence of an attending physician at a trauma resuscitation. Our data from the NTDB involving hospitalized injured patients suggest that nonclinical factors significantly affect LOS. All Rights Reserved. Other papers that have examined LOS in surgical oncology have tried to relate it to high-volume centers and to complexity of cases. Conducted within the OhioHealth system, this relatively minor intervention suggests that oncologists can change their behavior and refer patients earlier to hospice care. Administrative, technical, and material support: Brasel and Weigelt. There are a lot of nondesignated centers in the NTDB or centers that have chosen not to report a designation. The ALOS refers to the average … In addition, a multidisciplinary approach would be essential to improve the entire discharge process. While extended LOS certainly demonstrates holes in our health care system, is this an appropriate measure of quality of care in a trauma center? We did look at some interaction terms. Statistical analysis was performed using generalized linear modeling adjusted for multiple comparisons. Many facilities that submit data to the NTDB do not include financial information such as payer type. Building on the foundations established by Shewhart17 and Deming,18 Donabedian19 enumerated the 3 essential components necessary to measure the quality of health care—structure, process, and outcome.  et al.  Disparities in the utilization of high-volume hospitals for complex surgery.Â, Brasel Although injury severity was significantly associated with extended LOS, other factors had much stronger associations. 3g�h��ۖ�5��$eOS_�]C�Ҍ;t}����M�-^7��!������[������di��6ɘZ��y�$|')�[���k�2-�+������� ��� endstream endobj 409 0 obj <>stream  KMKoch Forty percent of the patients had commercial insurance, 11% had Medicaid, 25% had Medicare, 16% were uninsured, and 9% had other insurance. Length of hospital stay (LOS) following surgical cancer care is an important measure of short-term quality of care. They do not adjust for injury severity or anything specific to trauma populations.  RJJacobs Other reasons for an extended LOS may relate to its surrogate for socioeconomic status, including nutritional status, social support networks, and incidence of posttraumatic stress disorder.  SL Effect of pre-existing disease on length of hospital stay in trauma patients.Â, McAleese Patients with head, face or neck, and thorax injuries had stays shorter then the mean, and those with abdominal and spine injuries had stays longer then the mean, However, the magnitude of these associations, as well as the associations of sex, age, Injury Severity Score, and Revised Trauma Score, was relatively small compared with discharge destination and payer type status. As a medical director of a hospital trauma service line, I am informed on a quarterly basis about our direct variable costs and where the service is in relation to our goal. Business and industry have recognized the importance of this topic through the Leapfrog Initiative. Did mechanism of injury, for example, blunt vs penetrating trauma or an assault vs a motor vehicle crash, have a significant effect on LOS? Mean LOS was 9.6 days. However, an assumption that cuts through most performance improvement or quality programs is that attention to structure and process will result in better outcomes. doi:10.1001/archsurg.142.5.461. Your categories of discharge destination were somewhat broad. A simple comparison using injury severity will be inadequate. However, there was a significant interaction effect between race/ethnicity × payer status on LOS (Table 2). Length of stay could become a monitor for how well a community and a trauma system is identifying and managing available LTACF beds in the community. Customize your JAMA Network experience by selecting one or more topics from the list below. Medicaid patients and those designated as self-payers were associated with an extended LOS (Table 2).  et al.  “Ideal” length of stay after colectomy: whose ideal?Â, Schwartz It is my impression that victims of violent acts are much more difficult to place and, thus, have a prolonged LOS even though their injuries are essentially equivalent to those of others. R. Stephen Smith, MD, Wichita, Kan: Since the report “To Err Is Human” was published by the Institute of Medicine in 2000, there has been an appropriate emphasis on quality of care and performance improvement. Dr Brasel: We looked at this about 4 years ago and found that about 25% to 30% of our extended LOS on a prospective basis was completely nonmedical. A simple quality improvement project to increase duration of hospice care for patients has doubled hospice length of stay, reaching the national median in 1 year. In multivariate analysis, factors significantly associated with extended LOS included age, sex, race/ethnicity, insurance status, discharge destination, and Revised Trauma Score. Are you certain that your data are broadly representative of patients with injury? The ACA has brought to light the importance of collecting data and using quality and outcome measures to determine how well an entity is performing. In your first slide, you showed that the UHC did have risk-adjusted LOS. The influence of race/ethnicity and payment type on other outcome measures of resource use has been noted by others.27-29 Liu et al27 found that Medicaid patients, blacks, Hispanics, and Asians were less likely to receive complex surgical care at high-volume hospitals.  LW Nonclinical factors significantly influence LOS. 2007;142(5):461–466. Length of stay greater than the mean. However, it becomes overwhelmed by those other nonclinical factors. If you are just discharging people from the hospital after a first admission and they return and are readmitted for another 4, 5, or 6 days, that probably does not influence resource consumption and may be an indicator of poorer quality of care rather than improved quality of care. Payer status had the next greatest effect; Medicare patients were significantly associated with an LOS less than the mean compared with patients with commercial insurance (odds ratio, 0.77; 95% confidence interval, 0.73-0.82). Length of stay is a commonly used outcome measure. Discharge destination was grouped into the following 5 categories: home (home, home with home health assistance, jail, or psychiatric facility), rehabilitation facility, nursing home (skilled nursing facility or nursing home), another hospital, and other (unknown discharge destination or patient unable to complete treatment). It can be tracked by a specific timeframe or d…  SNMcGwin The relationship of LOS, effectiveness, and efficiency may not always be direct. Commercial entities such as HealthGrades have attempted to assess the quality of care provided by both institutions and physicians and have made their conclusions available to the public. •Any characteristic that can take on more than one form or value. Hospital length of stay (LOS) has long been a crucial barometer of hospital efficiency and quality of care. Patients with Medicaid insurance had the longest stay (mean ± SD), 11.3 ± 15.8 days, while those with Medicare insurance had the shortest stay, 8.8 ± 11.3 days (Table 3).  L title = "Length of stay: An appropriate quality measure? ", abstract = "Hypothesis: Although demographic and clinical information are known to affect hospital length of stay (LOS), we hypothesized that LOS after traumatic injury would be significantly influenced by nonclinical factors.

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