title: Length of stay, conditional length of stay, and prolonged stay in pediatric asthma.
abstract: OBJECTIVE
  To understand differences in length of stay for asthma patients between New York State and Pennsylvania across children's and general hospitals in order to better guide policy.
  
  
  METHODS
  All pediatric admissions for asthma in the states of Pennsylvania and New York using claims data obtained from each state for the years 1996-1998, n = 38,310.
  
  
  METHODS
  A retrospective cohort design to model length of stay (LOS), the probability of prolonged stay, conditional length of stay (CLOS or the LOS after stay is prolonged), and the probability of readmission, controlling for patient factors, state, location and hospital type. ANALYTIC METHODS: Logit models were used to estimate the probability of prolonged stay and readmission. The LOS and the CLOS were estimated with Cox regression. Model variables included comorbidities, income, race, distance from hospital, and insurance type. Prolonged stay was based on a Hollander-Proschan "New-Worse-Than-Used" test, corresponding to a three-day stay.
  
  
  RESULTS
  The LOS was longer in New York than Pennsylvania, and the probabilities of prolonged stay and readmission were much higher in New York than Pennsylvania. However, once an admission was prolonged, there were no differences in CLOS between states (when readmissions were not added to the LOS calculation). In both states, children's hospitals and general hospitals had similar adjusted LOS.
  
  
  CONCLUSIONS
  Management of asthma appears more efficient in Pennsylvania than New York: Less severe patients are discharged faster in Pennsylvania than New York; once discharged, patients are less likely to be readmitted in Pennsylvania than New York. However, once a stay is prolonged, there is little difference between New York and Pennsylvania, suggesting medical care for severely ill patients is similar across states. Differences between children's and general hospitals were small as compared to differences between states. We conclude that policy initiatives in New York, and other states, should focus their efforts on improving the care provided to less severe patients in order to help reduce overall length of stay.
authors.affiliation: The Center for Outcomes Research, The Children's Hospital of Philadelphia, PA 19104, USA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Silber
authors.forename: Paul R
authors.initials: PR
authors.lastname: Rosenbaum
authors.forename: Orit
authors.initials: O
authors.lastname: Even-Shoshan
authors.forename: Mayadah
authors.initials: M
authors.lastname: Shabbout
authors.forename: Xuemei
authors.initials: X
authors.lastname: Zhang
authors.forename: Eric T
authors.initials: ET
authors.lastname: Bradlow
authors.forename: Roger R
authors.initials: RR
authors.lastname: Marsh
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D017598:Efficiency, Organizational; D005260:Female; D006302:Health Services Research; D006769:Hospitals, General / Q000458:organization & administration / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D009518:New York; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D010414:Pennsylvania; D012189:Retrospective Studies; D013997:Time Factors; D014600:Utilization Review