A province-wide study of the association between hospital resource allocation and length of stay

Abstract

The relationship between hospital resource allocation and clinical efficiency is poorly understood. Within the single-payer healthcare system in Ontario, Canada, the association between hospital spending patterns and length of stay was studied using data from 1117090 patient discharges in 1997/8 at 162 of 171 acute care hospitals. A weighted regression model was created using an overall hospital length of stay index (actual length of stay divided by predicted length of stay) as the dependent variable. Control variables included: hospital size, teaching activity, occupancy rate, rural location and geographic region. Four independent spending variables were defined as a percentage of total hospital spending: nursing, ambulatory care, administration and support, and diagnostics and therapeutics. The reduced regression model had an r-squared of 0.45. Across all spending variables, hospitals spending relatively too little or too much had significantly longer length of stay. Hospitals' overall pattern of resource allocation was also significantly associated with length of stay. Thus, measurable clinical effects can be seen with resource allocation decisions made by hospital management, supporting the need for rigorous decision-making processes. Future research should focus on exploring the nature of this relationship and the potential interdependencies among hospital services that cause this effect.

A review of statistical estimators for risk-adjusted length of stay: analysis of the Australian and new Zealand intensive care adult patient data-base, 2008–2009

“…It is widely used as an indicator of performance [2] and is a determinant of costs, although resource allocation is also known to affect length of stay [3]. Not surprisingly, ICU length of stay has been the subject of frequent analysis [4-9], with the majority of studies presenting cross-sectional analyses over a relatively short periods of months [10] to 1–2 years [9].…”

A Core Outcome Set for Critical Care Ventilation Trials

“…Participants recognized that achieving standardized measures of length of stay was challenging due to international differences in healthcare provision. Length of stay is generally used as a benchmark to assess healthcare systems, with shorter stays typically associated with system efficiency (24) and for this reason, it was deemed important for the COS. Although length of stay may reflect important progress in a patient’s trajectory of recovery, structural and process factors may impact its standardization.…”

The impact of HIV diagnosis on length of hospital stay in New York City, NY, USA

“…Prolonged hospital stays are also commonly associated with hospital-acquired infections among those already affected by infectious diseases (Dulworth & Pyenson, 2004; Mohammed, Furuya, & Larson, 2014). Longer stays in the hospital place a substantial burden on hospital and health insurance systems (Shih et al, 2011), typically requiring more resources for treatment (Needham et al, 2003; Papi, Pontecorvi, & Setola, 2016). …”