title: Factors associated with prolonged length of hospital stay of elderly patients in acute care hospitals in Japan: a multilevel analysis of patients with femoral neck fracture.
abstract: OBJECTIVE
  To analyze possible factors associated with prolonged length of stay (LOS) in hip fracture patients in Japan, such as the availability of beds in medical and nursing care facilities at the community level, as well as patient factors, clinical factors and hospital structural characteristics.
  
  
  METHODS
  The sample for analysis consisted of 8318 hip fracture cases from 199 hospitals throughout Japan. We conducted multilevel analyses to investigate whether LOS and the discharge destinations of patients are associated with the availability and utilization of medical and nursing care resources in the communities where each hospital is located.
  
  
  RESULTS
  After adjusting for patient factors, clinical factors and hospital structural characteristics, a higher number of long-term care beds at the community level was observed to be significantly correlated with both shorter LOS and increased rate of discharge to other facilities.
  
  
  CONCLUSIONS
  Although the Japanese government is attempting to reduce acute care hospital LOS and the number of long-term care beds in order to reduce health care costs, the results of this study suggest that a reduction in the number of long-term care beds would not necessarily reduce the LOS of acute care hospitals, and may instead exacerbate the problem.
authors.affiliation: Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan. motohashi.takako.67a@st.kyoto-u.ac.jp
authors.forename: Takako
authors.initials: T
authors.lastname: Motohashi
authors.forename: Hironori
authors.initials: H
authors.lastname: Hamada
authors.forename: Jason
authors.initials: J
authors.lastname: Lee
authors.forename: Miho
authors.initials: M
authors.lastname: Sekimoto
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Imanaka
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001509:Bed Occupancy / Q000706:statistics & numerical data; D005260:Female; D005265:Femoral Neck Fractures / Q000453:epidemiology / Q000628:therapy*; D006782:Hospitals, Special / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009735:Nursing Homes / Q000600:supply & distribution; D010351:Patient Discharge / Q000706:statistics & numerical data; D012737:Sex Factors