title: International medical travelers, length of stay, and the continuum of care: inquiry and comparison.
abstract: OBJECTIVE
  In this study, we assess whether length of stay (LOS) is associated with patient geographic origin and whether payment source for international patients explains differences in LOS.
  
  
  METHODS
  We used a retrospective case-control study to compare inbound international patients coming to the United States and domestic patients, who were admitted to academic medical centers (AMCs) between October 2005 and September 2008. International patients were matched to domestic patients on the basis of age, gender, AMC, admission status, severity of illness (SOI), and Medicare Severity Diagnosis-Related Group.
  
  
  RESULTS
  International patients stayed significantly longer than domestic patients, with an average LOS of 6.9 days (SD = 14.0) compared with 6.0 days (SD = 5.3) for domestic patients (P < .001). There was no difference in LOS between patients with international commercial and international self-pay payment sources (P = .108). Results of the multivariate analysis showed that international patients with extreme SOI stayed 21% longer than otherwise similar domestic patients with extreme SOI (P = .012).
  
  
  CONCLUSIONS
  The most complex international patients coming to US AMCs have substantially longer LOS than the most complex domestic patients, even after controlling for demographic characteristics, and type of condition. More research is needed to understand the underlying drivers of these differences.
authors.affiliation: Operations Integration, Johns Hopkins Health System, Baltimore, Maryland 21287, USA. ssatjapot@gmail.com
authors.forename: Siriporn Patricia
authors.initials: SP
authors.lastname: Satjapot
authors.forename: Tricia J
authors.initials: TJ
authors.lastname: Johnson
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Garman
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014195:Travel / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult