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. 1995 Mar 1;152(5):675–682.

Variation in length of stay as a measure of efficiency in Manitoba hospitals.

M D Brownell 1, N P Roos 1
PMCID: PMC1337615  PMID: 7882230

Abstract

OBJECTIVE: To examine the efficiency of Manitoba hospitals by analysing variations in length of stay for patients with similar characteristics. DESIGN: Retrospective study. Multiple regression analyses were used to adjust for patient (case-mix) characteristics and to identify differences in length of stay attributable to the hospital of admission for 14 specific, frequently encountered diagnostic categories and for all acute admissions. SETTING: The eight major acute care hospitals in Manitoba. PARTICIPANTS: Manitoba residents admitted to any one of the eight hospitals during the fiscal year 1989-90, 1990-91 or 1991-92. Patients transferred to or from another institution, those with atypically long stays and those who died in hospital were excluded. OUTCOME MEASURE: Length of hospital stay. RESULTS: The length of stay was strongly influenced by hospital of admission, even after adjustment for key patient characteristics. Excluding the most seriously ill patients and those with the longest stays, approximately 186 beds could potentially have been saved if each hospital had discharged its patients as efficiently as the hospital with the shortest overall length of stay. CONCLUSIONS: A substantial proportion of days currently invested in treating acute care patients could be eliminated. At least some bed closures in Manitoba hospitals could be accommodated simply through more efficient treatment of patients in the remaining beds, without decreasing access to hospital care.

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Selected References

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  1. Cleary P. D., Greenfield S., Mulley A. G., Pauker S. G., Schroeder S. A., Wexler L., McNeil B. J. Variations in length of stay and outcomes for six medical and surgical conditions in Massachusetts and California. JAMA. 1991 Jul 3;266(1):73–79. [PubMed] [Google Scholar]
  2. DesHarnais S., Hogan A. J., McMahon L. F., Jr, Fleming S. Changes in rates of unscheduled hospital readmissions and changes in efficiency following the introduction of the Medicare prospective payment system. An analysis using risk-adjusted data. Eval Health Prof. 1991 Jun;14(2):228–252. doi: 10.1177/016327879101400206. [DOI] [PubMed] [Google Scholar]
  3. Epstein A. M., Stern R. S., Weissman J. S. Do the poor cost more? A multihospital study of patients' socioeconomic status and use of hospital resources. N Engl J Med. 1990 Apr 19;322(16):1122–1128. doi: 10.1056/NEJM199004193221606. [DOI] [PubMed] [Google Scholar]
  4. Iezzoni L. I., Foley S. M., Daley J., Hughes J., Fisher E. S., Heeren T. Comorbidities, complications, and coding bias. Does the number of diagnosis codes matter in predicting in-hospital mortality? JAMA. 1992 Apr 22;267(16):2197–2203. doi: 10.1001/jama.267.16.2197. [DOI] [PubMed] [Google Scholar]
  5. Manheim L. M., Feinglass J., Shortell S. M., Hughes E. F. Regional variation in Medicare hospital mortality. Inquiry. 1992 Spring;29(1):55–66. [PubMed] [Google Scholar]
  6. Manton K. G., Woodbury M. A., Vertrees J. C., Stallard E. Use of Medicare services before and after introduction of the prospective payment system. Health Serv Res. 1993 Aug;28(3):269–292. [PMC free article] [PubMed] [Google Scholar]
  7. McMahon L. F., Jr, Hayward R. A., Bernard A. M., Rosevear J. S., Weissfeld L. A. APACHE-L: a new severity of illness adjuster for inpatient medical care. Med Care. 1992 May;30(5):445–452. doi: 10.1097/00005650-199205000-00006. [DOI] [PubMed] [Google Scholar]
  8. Newhouse J. P., Anderson G., Roos L. L. Hospital spending in the United States and Canada: a comparison. Health Aff (Millwood) 1988 Winter;7(5):6–16. doi: 10.1377/hlthaff.7.5.6. [DOI] [PubMed] [Google Scholar]
  9. Redelmeier D. A., Fuchs V. R. Hospital expenditures in the United States and Canada. N Engl J Med. 1993 Mar 18;328(11):772–778. doi: 10.1056/NEJM199303183281107. [DOI] [PubMed] [Google Scholar]
  10. Roos L. L., Jr, Roos N. P., Cageorge S. M., Nicol J. P. How good are the data? Reliability of one health care data bank. Med Care. 1982 Mar;20(3):266–276. doi: 10.1097/00005650-198203000-00003. [DOI] [PubMed] [Google Scholar]
  11. Schieber G. J., Poullier J. P., Greenwald L. M. U.S. health expenditure performance: an international comparison and data update. Health Care Financ Rev. 1992 Summer;13(4):1–87. [PMC free article] [PubMed] [Google Scholar]
  12. Woolhandler S., Himmelstein D. U. The deteriorating administrative efficiency of the U.S. health care system. N Engl J Med. 1991 May 2;324(18):1253–1258. doi: 10.1056/NEJM199105023241805. [DOI] [PubMed] [Google Scholar]

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