Do severity measures explain differences in length of hospital stay? The case of hip fracture.
OBJECTIVE
To examine whether judgments about hospital length of stay (LOS) vary depending on the measure used to adjust for severity differences.


METHODS
Data on admissions to 80 hospitals nationwide in the 1992 MedisGroups Comparative Database.


METHODS
For each of 14 severity measures, LOS was regressed on patient age/sex, DRG, and severity score. Regressions were performed on trimmed and untrimmed data. R-squared was used to evaluate model performance. For each severity measure for each hospital, we calculated the expected LOS and the z-score, a measure of the deviation of observed from expected LOS. We ranked hospitals by z-scores.


METHODS
All patients admitted for initial surgical repair of a hip fracture, defined by DRG, diagnosis, and procedure codes.


RESULTS
The 5,664 patients had a mean (s.d.) LOS of 11.9 (8.9) days. Cross-validated R-squared values from the multivariable regressions (trimmed data) ranged from 0.041 (Comorbidity Index) to 0.165 (APR-DRGs). Using untrimmed data, observed average LOS for hospitals ranged from 7.6 to 23.9 days. The 14 severity measures showed excellent agreement in ranking hospitals based on z-scores. No severity measure explained the differences between hospitals with the shortest and longest LOS.


CONCLUSIONS
Hospitals differed widely in their mean LOS for hip fracture patients, and severity adjustment did little to explain these differences.
Shwartz
M
M
Department of Medicine, Beth Israel Hospital, Boston, MA 02215, USA.
Iezzoni
L I
LI
Ash
A S
AS
Mackiernan
Y D
YD
D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D005260:Female; D006302:Health Services Research / Q000379:methods; D006620:Hip Fractures / Q000145:classification* / Q000191:economics / Q000601:surgery; D006761:Hospitals / Q000145:classification / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D015233:Models, Statistical; D016311:Outliers, DRG / Q000706:statistics & numerical data; D011379:Prognosis; D012044:Regression Analysis; D012720:Severity of Illness Index; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data