Length of in-patient stay in teaching hospitals in Japan

Abstract

The average length of in-patient stay (LOS) in Japan is longer than that of the other Organization for Economic Cooperation and Development (OECD) countries. The tendency towards long LOS is also apparent in teaching hospitals in Japan. This paper examines factors responsible for the long LOS in teaching hospitals, focusing on conditions of residency training. The study was conducted as a part of the first nation-wide study of teaching hospitals for postgraduate medical education in Japan and covered most teaching hospitals (61 university hospitals out of 80 and 153 non-university general hospitals out of 193). The multivariate analysis suggested that longer LOS was more common in the hospitals with lower autopsy rate per bed, higher operation rate per admission, and smaller number of in-patients (P < 0.01, respectively). It was also suggested that those hospitals where residents decided a work-up plan and where residents were engaged in out-patient clinics tended to show shorter LOS (P < 0.05, respectively). The results indicated that LOS was related to not only general characteristics of the hospitals but also the conditions of residency training.

Impact of sociocultural factors on hospital length of stay in children with nephrotic syndrome in Japan

“…No medical or clinical factors played a major role in the prolonged LOS, as shown by multivariate Cox's regression with time-dependent covariates. Previous studies have suggested that multiple factors are involved in the tendency for long LOS in Japan [3,5,7,23]. Characteristic features of the medical insurance payment and reimbursement systems in Japan have been reported to have a major impact on this tendency [2].…”

“…Muramatsu and Liang reported that differences in medical insurance and reimbursement systems play a major role in the difference in LOS [2], but little is known about the factors that affect the tendency for a long LOS in Japan [3][4][5][6][7]. Many factors, including patient background (age, gender, race, lifestyle, etc.…”

Early readmission and length of hospitalization practices in the Dialysis Outcomes and Practice Patterns Study (DOPPS)

“…It is possible that the trend toward shorter LOS for dialysis patients in the United States is driven by the Medicare prospective payment system, which provides a financial incentive for shorter hospital stays 27 . The incentive to shorten LOS is apparently weaker in other countries, particularly in Japan 26,28 . In fact, the longer hospital LOS in Japan seems to be a general phenomenon rather than a finding specific for hemodialysis patients.…”

“…27 The incentive to shorten LOS is apparently weaker in other countries, particularly in Japan. 26,28 In fact, the longer hospital LOS in Japan seems to be a general phenomenon rather than a finding specific for hemodialysis patients. It is possible that the hospital LOS practices in Europe and Japan exceed the threshold at which a measurable impact on readmission risk can be detected.…”

Improvement of residents' clinical competency after the introduction of new postgraduate medical education program in Japan

“…At university hospitals in Japan, physicians with more experience have traditionally provided the care for outpatients, while residents have been in charge of the inpatients. In contrast, second-year residents at non-university hospitals may see outpatients and have more opportunities to gain clinical experience because fewer specialists and clinical departments exist at non-university hospitals than at university hospitals (Niino et al 1989;Yano et al 1992;Yamaoka et al 1993 This shift of residents from university hospitals to nonuniversity hospitals may explain the improvement in the outcomes as a whole. We therefore suggest that the evaluation of residency programmes must be standardized to distinguish the difference in outcomes between the two types of hospitals.…”