Does Reducing Length of Stay Increase Rehospitalization of Medicare Fee-for-Service Beneficiaries Discharged to Skilled Nursing Facilities?

作者：Unruh Mark A^*; Trivedi Amal N; Grabowski David C; Mor Vincent

来源：Journal of the American Geriatrics Society, 2013, 61(9): 1443-1448.

DOI：10.1111/jgs.12411

• Medicare
• quality of care
• skilled nursing facilities
• length of stay
• rehospitalization

Objectives
To analyze the relationship between length of stay and rehospitalization.
Design
Retrospective cohort study.
Setting
Six thousand five hundred thirty-seven hospitals nationwide from January 1999 through September 2005.
Participants
Medicare fee-for-service beneficiaries associated with 2,101,481 hospitalizations.
Measurements
Thirty-day rehospitalization derived from Medicare hospital claims using the implementation of Medicare's post-acute care transfer policy as a quasi-experiment.
Results
Medicare's post-acute care transfer policy led to immediate declines in length of stay. A 1-day decrease in length of stay was associated with an absolute increase in 30-day rehospitalization of 1.56 percentage points (95% confidence interval (CI) = 0.30-2.82) for acute myocardial infarction (AMI) with major complications and 0.81 percentage points (95% CI = 0.03-1.60) for kidney infection or urinary tract infection (UTI) without major complications. Individuals hospitalized for AMI without major complications, heart failure, or kidney infection or UTI with major complications had no increase in 30-day rehospitalization.
Conclusion
A 1-day reduction in hospital length of stay was not consistently associated with a higher rate of rehospitalization.

• 出版日期2013-9