title: Prolonged length of stay in hospitalized internal medicine patients.
abstract: BACKGROUND
  Targeting patients with prolonged hospitalizations may represent an effective strategy for reducing average hospital length of stay (LOS).
  
  
  OBJECTIVE
  We sought to characterize predictors of prolonged hospitalization among internal medicine patients in an effort to guide future improvement efforts.
  
  
  METHODS
  We conducted a retrospective cohort study using administrative data of internal medicine patients from all hospitals of the Spanish Public Health Service between January 1st, 2005 and December 31st, 2013. Multivariable logistic regression was performed to assess the association between sociodemographic and clinical variables and prolonged LOS, defined as >30days.
  
  
  RESULTS
  Of 5,275,139 discharges, 166,470 (3.2%) had a prolonged LOS. Prolonged hospitalizations accounted for 17.4% of total inpatient days and contributed 0.5days to an average LOS of 9.8days during the study period. Prolonged hospitalizations were associated with younger age (odds ratio [OR]: 0.97 per 10-year increase in age, 95% confidence interval [CI]: 0.96-0.98) and male gender (OR 0.88 IC95% 0.87-0.89). Compared to patients without prolonged LOS, prolonged LOS patients were more likely to require a palliative care consult (OR: 2.48, 95% CI: 2.39-2.58), surgery (OR: 6.9 95% CI: 6.8-7.0); and be discharged to a post-acute-care facility (OR: 2.91, 95% CI: 2.86-2.95).
  
  
  CONCLUSIONS
  Prolonged hospitalizations in a small proportion of patients were an important contributor to overall LOS and particularly affected complex hospital stays who were not discharged home.
authors.affiliation: Department of Internal Medicine, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain. Electronic address: raquel.barba@hospitalreyjuancarlos.es.
authors.forename: Raquel
authors.initials: R
authors.lastname: Barba
authors.affiliation: Department of Internal Medicine, Hospital Clínico de San Carlos, Madrid, Spain. Electronic address: javier.marco@elmundo.es.
authors.forename: Javier
authors.initials: J
authors.lastname: Marco
authors.affiliation: Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain. Electronic address: jcanora.hflr@salud.madrid.org.
authors.forename: Jesús
authors.initials: J
authors.lastname: Canora
authors.affiliation: Department of Internal Medicine, Hospital Severo Ochoa, Leganés, Madrid, Spain. Electronic address: splaza.hsvo@salud.madrid.org.
authors.forename: Susana
authors.initials: S
authors.lastname: Plaza
authors.affiliation: Department of Internal Medicine, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain. Electronic address: sara.nistal@hospitalreyjuancalos.es.
authors.forename: Sara Nistal
authors.initials: SN
authors.lastname: Juncos
authors.affiliation: Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain. Electronic address: jhinojosa.hflr@salud.madrid.org.
authors.forename: Juan
authors.initials: J
authors.lastname: Hinojosa
authors.affiliation: Department of Internal Medicine, Hospital Clínico de San Carlos, Madrid, Spain. Electronic address: manuel.mendez@salud.madrid.org.
authors.forename: Manuel Mendez
authors.initials: MM
authors.lastname: Bailon
authors.affiliation: Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain. Electronic address: azapatero.hflr@salud.madrid.org.
authors.forename: Antonio
authors.initials: A
authors.lastname: Zapatero
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000379:methods / Q000458:organization & administration; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000458:organization & administration / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010362:Patients' Rooms / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain; D013997:Time Factors
keywords: Administrative data; Hospital length of stay; Medical patients