Does reducing length of stay increase rehospitalization of medicare fee-for-service beneficiaries discharged to skilled nursing facilities?
OBJECTIVE
To analyze the relationship between length of stay and rehospitalization.


METHODS
Retrospective cohort study.


METHODS
Six thousand five hundred thirty-seven hospitals nationwide from January 1999 through September 2005.


METHODS
Medicare fee-for-service beneficiaries associated with 2,101,481 hospitalizations.


METHODS
Thirty-day rehospitalization derived from Medicare hospital claims using the implementation of Medicare's post-acute care transfer policy as a quasi-experiment.


RESULTS
Medicare's post-acute care transfer policy led to immediate declines in length of stay. A 1-day decrease in length of stay was associated with an absolute increase in 30-day rehospitalization of 1.56 percentage points (95% confidence interval (CI) = 0.30-2.82) for acute myocardial infarction (AMI) with major complications and 0.81 percentage points (95% CI = 0.03-1.60) for kidney infection or urinary tract infection (UTI) without major complications. Individuals hospitalized for AMI without major complications, heart failure, or kidney infection or UTI with major complications had no increase in 30-day rehospitalization.


CONCLUSIONS
A 1-day reduction in hospital length of stay was not consistently associated with a higher rate of rehospitalization.
Center for Healthcare Informatics and Policy, Weill Medical College, Cornell University, New York, New York; Department of Public Health, Weill Cornell Medical College, New York, New York.
Mark A
MA
Unruh
Amal N
AN
Trivedi
David C
DC
Grabowski
Vincent
V
Mor
D000369:Aged, 80 and over; D018588:Fee-for-Service Plans / Q000191:economics* / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000191:economics / Q000628:therapy*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000639:trends*; D008297:Male; D006278:Medicare / Q000191:economics / Q000639:trends*; D010351:Patient Discharge / Q000191:economics*; D010359:Patient Readmission / Q000191:economics; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities / Q000191:economics*; D014481:United States
Medicare; length of stay; quality of care; rehospitalization; skilled nursing facilities