Abstract
OBJECTIVE: With the advent of hospital payment by diagnosis-related group (DRG), length of stay (LOS) has become a major issue in hospital efforts to control costs. Because the Columbia-Presbyterian Medical Center (CPMC) has had above-average LOSs for many DRGs, the authors tested the hypothesis that a computer-generated informational message directed to physicians would shorten LOS. DESIGN: Randomized clinical trial with the patient as the unit of randomization. SETTING AND STUDY POPULATION: From June 1991 to April 1993, at CPMC in New York, 7,109 patient admissions were randomly assigned to an intervention (informational message) group and 6,990 to a control (no message) group. INTERVENTION: A message giving the average LOS for the patient's admission or provisional DRG, as assigned by hospital utilization review, and the current LOS, in days, was included in the main menu for review of test results in the hospital's clinical information system, available at all nursing stations in the hospital. MAIN OUTCOME MEASURE: Hospital LOS. RESULTS: The median LOS for study patients was 7 days. After adjustment for covariates including age, sex, payor, patient care unit, and time trends, the mean LOS in the intervention group was 3.2% shorter than that in the control group (p = 0.022). CONCLUSION: Computer-generated patient-specific LOS information directed to physicians was associated with a reduction in hospital LOS.
Full Text
The Full Text of this article is available as a PDF (745.6 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Arons R. R., Milo B. J., Yee R., Ginsberg D. L., Lieberman J. S. A length of stay study of the dually entitled Medicare and Medicaid population: challenges for managed competition. Manag Care Q. 1994 Autumn;2(4):89–99. [PubMed] [Google Scholar]
- Doskocil M., Med M., Vimmer T. Musculus rectus femoris--zacátecní slacha, její funkcní význam. Acta Chir Orthop Traumatol Cech. 1987 Apr;54(2):99–107. [PubMed] [Google Scholar]
- Grimshaw J. M., Russell I. T. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993 Nov 27;342(8883):1317–1322. doi: 10.1016/0140-6736(93)92244-n. [DOI] [PubMed] [Google Scholar]
- Johnston M. E., Langton K. B., Haynes R. B., Mathieu A. Effects of computer-based clinical decision support systems on clinician performance and patient outcome. A critical appraisal of research. Ann Intern Med. 1994 Jan 15;120(2):135–142. doi: 10.7326/0003-4819-120-2-199401150-00007. [DOI] [PubMed] [Google Scholar]
- Parenti C. M. Changing the fourth-year medicine clerkship structure: a successful model for a teaching service without housestaff. J Gen Intern Med. 1993 Jan;8(1):31–32. doi: 10.1007/BF02600292. [DOI] [PubMed] [Google Scholar]
- Pugh J. A., Frazier L. M., DeLong E., Wallace A. G., Ellenbogen P., Linfors E. Effect of daily charge feedback on inpatient charges and physician knowledge and behavior. Arch Intern Med. 1989 Feb;149(2):426–429. [PubMed] [Google Scholar]
- Selker H. P., Beshansky J. R., Pauker S. G., Kassirer J. P. The epidemiology of delays in a teaching hospital. The development and use of a tool that detects unnecessary hospital days. Med Care. 1989 Feb;27(2):112–129. doi: 10.1097/00005650-198902000-00003. [DOI] [PubMed] [Google Scholar]
- Spiegel J. S., Shapiro M. F., Berman B., Greenfield S. Changing physician test ordering in a university hospital. An intervention of physician participation, explicit criteria, and feedback. Arch Intern Med. 1989 Mar;149(3):549–553. [PubMed] [Google Scholar]
- Tape T. G., Campbell J. R. Computerized medical records and preventive health care: success depends on many factors. Am J Med. 1993 Jun;94(6):619–625. doi: 10.1016/0002-9343(93)90214-a. [DOI] [PubMed] [Google Scholar]
- Tierney W. M., McDonald C. J., Hui S. L., Martin D. K. Computer predictions of abnormal test results. Effects on outpatient testing. JAMA. 1988 Feb 26;259(8):1194–1198. [PubMed] [Google Scholar]
- Tierney W. M., McDonald C. J., Martin D. K., Rogers M. P. Computerized display of past test results. Effect on outpatient testing. Ann Intern Med. 1987 Oct;107(4):569–574. doi: 10.7326/0003-4819-107-4-569. [DOI] [PubMed] [Google Scholar]
- Tierney W. M., Miller M. E., McDonald C. J. The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. N Engl J Med. 1990 May 24;322(21):1499–1504. doi: 10.1056/NEJM199005243222105. [DOI] [PubMed] [Google Scholar]
- Tierney W. M., Miller M. E., Overhage J. M., McDonald C. J. Physician inpatient order writing on microcomputer workstations. Effects on resource utilization. JAMA. 1993 Jan 20;269(3):379–383. [PubMed] [Google Scholar]