طولانی بودن مدت اقامت در بیمارستان
Abstract
1-Introduction
2-Material and methods
3-Results
4-Conclusion
References
Abstract
The growing financial problems of healthcare institutions contribute to the search for methods of properly distributing and clearly justifying resources. One of these is detecting the length of stay outliers (LOS) accounting for an important share of hospital costs. The purpose of this study is to analyze the factors facilitating identification of hospital LOS outliers. A total of 4570 patients were analyzed. To select the outliers, I used the inter-quartile method, using the median and the inter-quartile distance. The LOS outliers comprised 5,4% of the study sample and accounted for almost 15% of total hospital costs and 25% of total inpatient days. The median and range of the total costs for LOS outliers were (€) ۳۱۴۵,۲۶ (۱۹۳۰,۵۴-۴۶۷۰,۸۸). The status of an LOS outlier was associated with age and type of admission. Eighty three percent of the LOS were admitted to the hospital in an acute way. Most of the LOS outliers (56% of all LOS outliers) were younger than the mean for the study population. There was no significant correlation between the reason for discharge, the type of department or the gender and being an LOS outlier. It is concluded that identifying the LOS outliers can contribute to better knowledge of hospital costs and help the management of these institutions control those costs.
Introduction
Concern over the rising resources consumed by health care costs has become widespread in many countries in recent years. The growing year to year financial problems of health care sector entities have contributed to the intensive search for the causes of this situation and the solutions that could change it (Russell-Weisz et al., 2004; Freitas et al., 2012; Russell-Weisz et al., 2000). One of the ways to do this is to improve the system of managing the costs in hospitals. To do this, hospitals have attempted to develop a systematic approach for identifying the exceptional episodes connected with extreme lengths of stay. Moreover, the length of stay is an important measure of resource utilization. For this reason, analyzing the LOS outliers is fundamental for the management and financing of hospitals. Many hospitals have used or still use length of stay for managing the efficiency of resource utilization Prospective payment schemes in health care often include special funding for cost outliers. In order to share the risk of an extremely long stay of a patient in hospital, in many health care financial systems high LOS outliers receive additional payments for each day above the high outlier threshold (Antioch et al., 2007; Russell-Weisz et al., 2004).The separate reimbursement of outliers is important for protecting both patients and managers (Freitas et al., 2012).