title: The association of the number of comorbidities and complications with length of stay, hospital mortality and LOS high outlier, based on administrative data.
abstract: OBJECTIVE
  With greater concern for efficient resource allocation and profiling of medical care, a case-mix classification was applied for the per-diem payment system in Japan. Many questions remain, one of which is the role of comorbidity and complication (CC) in grouping logic. We examined the association of the number of CC with the length of hospital stay (LOS) and hospital mortality as well as the proportion of LOS high outliers in 19 major diagnostic categories (MDCs).
  
  
  METHODS
  This study was a secondary data analysis embedded in a government research project, including anonymous claims and clinical data during a 4-month period from July 2002. Every 19 MDC, LOS, hospital mortality or proportion of LOS high outliers was compared by the number of CC and presence of any procedures.
  
  
  RESULTS
  From 82 special function hospitals, 241,268 patients were enrolled in this study. Among all patients, 50.5% were identified without any CCs, 32.4% with one or two, 13.4% with three or four, and 3.7% with over five CCs. The overall mean LOS was 22.15 days and hospital mortality 26.05 cases per 1,000 admissions. In any MDC, LOS and the proportion of outliers increased as the number of CC rose. The mortality rate increased prominently in the respiratory system and the hematology system.
  
  
  CONCLUSIONS
  This study demonstrated that the occurrence of more CC caused longer LOS and higher mortality in some major disease categories. Further study will clarify the association of the weighted CC with resource use through controlling procedures specific for MDC.
authors: Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka, 812-8582, Japan, kazu228@basil.ocn.ne.jp
authors: Kazuaki
authors: K
authors: Kuwabara
authors: Yuichi
authors: Y
authors: Imanaka
authors: Shinya
authors: S
authors: Matsuda
authors: Kiyohide
authors: K
authors: Fushimi
authors: Hideki
authors: H
authors: Hashimoto
authors: Koichi B
authors: KB
authors: Ishikawa
authors: Hiromasa
authors: H
authors: Horiguchi
authors: Kenshi
authors: K
authors: Hayashida
authors: Kenji
authors: K
authors: Fujimori