Variation in Hospital Length of Stay: Do Physicians Adapt Their Length of Stay Decisions to What Is Usual in the Hospital Where They Work?

Abstract

Objective. To test the hypothesis that physicians who work in different hospitals adapt their length of stay decisions to what is usual in the hospital under consideration. Data Sources. Secondary data were used, originating from the Statewide Planning and Research Cooperative System (SPARCS). SPARCS is a major management tool for assisting hospitals, agencies, and health care organizations with decision making in relation to financial planning and monitoring of inpatient and ambulatory surgery services and costs in New York state. Study Design. Data on length of stay for surgical interventions and medical conditions (a total of seven diagnosis-related groups [DRGs]) were studied, to find out whether there is more variation between than within hospitals. Data (1999Data ( , 2000Data ( , and 2001) from all hospitals in New York state were used. The study examined physicians practicing in one hospital and physicians practicing in more than one hospital, to determine whether average length of stay differs according to the hospital of practice. Multilevel models were used to determine variation between and within hospitals. A t-test was used to test whether length of stay for patients of each multihospital physician differed from the average length of stay in each of the two hospitals. Principal Findings. There is significantly ( po.05) more variation between than within hospitals in most of the study populations. Physicians working in two hospitals had patient lengths of stay comparable with the usual practice in the hospital where the procedure was performed. The proportion of physicians working in one hospital did not have a consistent effect for all DRGs on the variation within hospitals. Conclusion. Physicians adapt to their colleagues or to the managerial demands of the particular hospital in which they work. The hospital and broader work environment should be taken into account when developing effective interventions to reduce variation in medical practice.

An even smaller area variation: Differing practice patterns among interventional cardiologists within a single high volume tertiary cardiac centre

“…One of the most compelling arguments maintains that practice variations are a result of differences in resource and/or environmental constraints [12,13,19,20]. Such factors are unlikely to play a significant role in explaining the variation observed here, as this study examined variation in practice within a single hospital unit, and thus, each physician was influenced by the same organizational/environmental constraints.…”

“…Our study differs from previous studies examining within centre variation in that such studies focused on aspects of practice that are not completely under the physician's control (e.g. length of stay) [13][14][15], whereas our study focused on the treatment recommendations by the physicians. Thus, the results from the study presented here are not directly comparable to those of previous studies.…”

“…Only a few studies have examined variations among physicians within centres (e.g. [13][14][15]). These studies have yielded mixed results regarding both the existence of practice variations within a group, and, in the event that they did exist, their determinants.…”

From an Overcrowded to a Smoothly Functioning Emergency Department within Two Months

“…In their study, they showed that physicians working in two hospitals with different average lengths of stay will influence the LOS of their patients according to their dominant place of work. This implies that physicians do not adapt to changing circumstances but instead bring their old work habits to their additional place of work [16]. In our hospital, in the last 5 years, 4 internal medicine departments` directors retired and they were all replaced by new directors from the existing staff.…”

Relating focus to quality and cost in a healthcare setting

“…All inpatient and outpatient data are reported back to hospitals annually at various levels of aggregation. SPARCS data have been used in several published research articles (Pasley et al 1995;Hainsworth et al 1997;Lagoe et al 2001;Noetscher et al 2001;de Jong et al 2004).…”