Association of health confidence with hospital length of stay and readmission

Abstract

BackgroundLength of stay (LOS) is an important measure of hospital quality and may be impacted by patient participation. However, concepts of patient participation, like health confidence, have received little examination in hospitalized patients' LOS, especially in diverse populations.ObjectiveTo determine if the Health Confidence Score (HCS) is associated with hospital LOS and readmission in a socioeconomically diverse population.Designs, Settings and ParticipantsWe conducted a prospective cohort study in 2022 of adult general medicine patients at an academic hospital in Chicago, Illinois.InterventionNone.Main Outcome and MeasuresPatient‐reported responses to the HCS (scored 0 [lowest health confidence] to ‒12 [highest health confidence]), as well as demographic, socioeconomic, and clinical questions, were collected. Primary outcome was LOS and secondary outcomes were 30‐ and 90‐day readmission.ResultsAmong 2797 socioeconomically diverse patients who completed the survey (response rate 28.5%), there was an average HCS of 9.19 (SD 2.68, range 0–12). Using linear regression, patients with high HCS (HCS ≥ 9) had a 1.53‐day lower LOS (p < .01, 95% CI [‐2.11, ‐0.95]) than patients with a low HCS (HCS < 9). This association remained when examining individual HCS questions and controlling for covariates. In logistic regression, HCS was not significantly associated with readmission, but the question “I am involved in decisions about me” (adjusted model: OR 0.83; 95% CI [0.71, 0.96]; p = .01) was associated with 90‐day readmission.