Variation in length of hospital stay in patients with community-acquired pneumonia: are shorter stays associated with worse medical outcomes? - 08/09/11
Abstract |
PURPOSE: To assess the variation in length of stay for patients hospitalized with community-acquired pneumonia and to determine whether patients who are treated in hospitals with shorter mean stays have worse medical outcomes.
SUBJECTS AND METHODS: We prospectively studied a cohort of 1,188 adult patients with community-acquired pneumonia who had been admitted to one community and three university teaching hospitals. We compared patients’ mean length of stay, mortality, hospital readmission, return to usual activities, return to work, and pneumonia-related symptoms among the four study hospitals. All outcomes were adjusted for baseline differences in severity of illness and comorbidity.
RESULTS: Adjusted interhospital differences in mean length of stay ranged from 0.9 to 2.3 days (P <0.001). When the risk of each medical outcome was compared between patients admitted to the hospital with the shortest length of stay and those admitted to longer stay hospitals, there were no differences in mortality [relative risk (RR) = 0.7; 95% CI, 0.3 to 1.7], hospital readmission (RR = 0.8; 95% CI, 0.5 to 1.2), return to usual activities (RR = 1.1; 95% CI, 0.9 to 1.3), or return to work (RR = 1.2; 95% CI, 0.8 to 2.0) during the first 14 days after discharge, or in the mean number of pneumonia-related symptoms 30 days after admission (P = 0.54).
CONCLUSIONS: We observed substantial interhospital variation in the lengths of stay for patients hospitalized with community-acquired pneumonia. The finding that medical outcomes were similar in patients admitted to the hospital with the shortest length of stay and those admitted to hospitals with longer mean lengths of stay suggests that hospitals with longer stays may be able to reduce the mean duration of hospitalization for this disease without adversely affecting patient outcomes.
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Supported in part by the Agency for Health Care Policy and Research as part of the Pneumonia Patient Outcomes Research Team project (R01 HS06468). Dr. McCormick was supported by an National Institutes of Health–sponsored Institutional National Research Service Award (5 T32 PE11001). Dr. Fine was supported in part as a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar. |
Vol 107 - N° 1
P. 5-12 - juillet 1999 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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