title: Length of stay variations between rural and urban patients with acute myeloid leukemia: a case-matched study.
abstract: BACKGROUND
  Keeping patients in hospital longer than medically necessary is costly and occupies resources that could be better utilised. If patients from regional areas remain in hospital longer because of logistical issues such as transport and accommodation, then there is an argument for establishing or expanding appropriate medical services for rural areas. However, if the length of stay (LOS) for rural and urban patients is similar, it could be surmised that current logistic services appropriately meet demand.
  
  
  METHODS
  This study reviews the cases of 40 patients with acute myeloid leukemia. This disease was selected as patients are generally required to travel to a metropolitan hospital for treatment, regardless of location. Twenty patients resided within the Sydney metropolitan area and 20 lived in rural New South Wales. Each of the 20 metropolitan patients were case-matched (1:1) with 20 rural patients with reference to sex, specific acute myeloid leukemia subtype (by World Health Organisation ICD-10 classification), and age.
  
  
  RESULTS
  Following statistical non-parametric (t-test) analysis, rural and urban medians were found to be very similar with a high t-value and small mean (urban median=29, rural median=29.5, t-value=0.722, m=-0.95, s.d.=15.236, two-tailed P=0.789, 95% CI=-7.89, 5.99). This demonstrates that there was no statistically significant difference between mean LOS for rural or urban patients after case-matching, a conclusion supported by qualitative analysis of the data.
  
  
  CONCLUSIONS
  Logistical issues are therefore unlikely to keep rural patients with AML in hospital beyond their immediate medical treatment. What is known about this topic? A United States-based study found that LOS in hospital for rural patients with human immunodeficiency virus was one-third longer than for urban patients across each of the 6 years analysed (from 1998 to 2003). However it was noted that after adjusting for covariates such as age and sex, differences between LOS for rural and urban residents were not of statistical significance. What does this paper add? This paper provides evidence that current services are utilised appropriately by demonstrating that rural and urban patients spend on average the same amount of time in hospital. Factors such as lack of transport or accommodation are therefore unlikely to keep rural patients in hospital beyond their immediate medical requirements. This paper adds to the limited research base within the Australian context. What are the implications for practitioners? It appears that support organisations adequately fulfil the needs of rural patients in the discharge process. LOS does not appear to correlate with the distance of residence from hospital. Practitioners should continue to support and encourage such support networks.
authors.affiliation: Nepean Hospital, Penrith, Australia. sean.heinz@hotmail.com
authors.forename: Sean J
authors.initials: SJ
authors.lastname: Heinz
authors.forename: Sam
authors.initials: S
authors.lastname: Milliken
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000379:methods / Q000706:statistics & numerical data; D014195:Travel / Q000706:statistics & numerical data