[Hospital LOS, medical complexity and deprivation indicators].
BACKGROUND
Several studies have shown that socioeconomic deprivation is associated with increased hospitalization lengths of stay (LOS) and costs. Yet, the French DRG-based information system (PMSI) does not take deprived situations into account. Hence, we aimed at extracting routinely available variables measuring deprivation from the Hospital Information System and at assessing their association with severity of illness and hospital LOS.


METHODS
We performed record linkage between the PMSI database concerning stays of patients aged more than 16years in the short-stay sector of Assistance publique-Hôpitaux de Paris in 2007 and an administrative database which provided the following deprivation measures: recipients of Couverture Médicale Universelle (basic or complementary health insurances adapted for underprivileged French citizens) or Aide Médicale d'Etat (health and medical emergency insurances adapted for underprivileged non French citizens living in France) and homeless patients. We compared length of stays showing a deprivation measure to others after adjustment on morbidity, age and sex.


RESULTS
Among 352,721 stays, the prevalence of the deprivation measures ranged from 0.71% for "homelessness" to 6.24% for complementary Couverture Médicale Universelle. Stays showing a deprivation measure had specific illnesses and had more frequently associated comorbidities or complications than others. After adjustment, deprivation measures were associated with significantly increased LOS (by 5% for Couverture Médicale Universelle to 48% for emergency Aide Médicale d'Etat.


CONCLUSIONS
Routine extraction of deprivation measures from Hospital Information Systems is feasible. Age, sex and illness being equal, these deprivation measures were associated with more complicated cases and increased LOS. We recommend that case mix-based hospital prospective payment systems take socioeconomic deprivation into account.
Département d'information médicale, Assistance publique-Hôpitaux de Paris, Paris cedex 04, France. josiane.holstein@sap.aphp.fr
J
J
Holstein
D
D
Farge
N
N
Taright
L
L
Trinquart
D
D
Manac'h
T
T
Bastianic
G
G
Chatellier
D000293:Adolescent; D000328:Adult; D000368:Aged; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010297:Paris; D011203:Poverty; D015995:Prevalence; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D035862:Vulnerable Populations