Mental illness-related disparities in length of stay: algorithm choice influences results.
Methodological challenges arise when one uses various Veterans Health Administration (VHA) data sources, each created for distinct purposes, to characterize length of stay (LOS). To illustrate this issue, we examined how algorithm choice affects conclusions about mental health condition (MHC)-related differences in LOS for VHA patients with diabetes nationally (n = 784,321). We assembled a record-level database of all fiscal year (FY) 2003 inpatient care. In 10 steps, we sequentially added instances of inpatient care from various VHA sources. We processed databases in three stages, truncating stays at the beginning and end of FY03 and consolidating overlapping stays. For patients with MHCs versus those without MHCs, mean LOS was 17.7 versus 13.6 days, respectively (p < 0.001), for the crudest algorithm and 37.2 versus 21.7 days, respectively (p < 0.001), for the most refined algorithm. Researchers can improve the quality of data applied to VHA systems redesign by applying methodological considerations raised by this study to inform LOS algorithm choice.
Center for Health Care Evaluation, Department of Veterans Affairs (VA) Palo Alto Health Care System, 795 Willow Road (152-MPD), Palo Alto, CA 94025, USA. sfrayne@stanford.edu
Susan M
SM
Frayne
Eric
E
Berg
Tyson H
TH
Holmes
Kaajal
K
Laungani
Dan R
DR
Berlowitz
Donald R
DR
Miller
Leonard
L
Pogach
Valerie W
VW
Jackson
Rudolf
R
Moos
D000328:Adult; D000368:Aged; D000465:Algorithms; D002755:Choice Behavior; D015331:Cohort Studies; D015897:Comorbidity; D019992:Databases as Topic; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006302:Health Services Research / Q000379:methods; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans