title: Have hospital readmissions increased in the face of reductions in length of stay? Evidence from England.
abstract: We assess the relationship between changes in hospital length of stay (LoS) and hospital quality, as measured by 28-day emergency readmission. We estimate regression models to analyse LoS and other factors associated with readmission for all those admitted for hip replacement (n=496,334), hernia repair (n=413,712) or following a stroke (n=480,113) in England between 2002/3 and 2007/8. There were reductions in LoS over time while changes in crude readmission rates varied by condition. Given the high mortality rate for stroke, it is critical to account for the probability of surviving the initial admission when evaluating readmissions. Conditional upon survival, the probability of readmission was greater for stroke patients who originally had a shorter LoS and for hernia patients who had an overnight stay but there is no relationship between LoS and readmission for patients who had hip replacement. The evidence does not generally suggest that reductions in LoS were associated with an increased probability of emergency readmission.
authors.affiliation: Department of Economics and Related Studies, University of York, York YO10 5DD, UK. Electronic address: stephen.martin@york.ac.uk.
authors.forename: Stephen
authors.initials: S
authors.lastname: Martin
authors.affiliation: Centre for Health Economics, University of York, York YO10 5DD, UK. Electronic address: andrew.street@york.ac.uk.
authors.forename: Andrew
authors.initials: A
authors.lastname: Street
authors.affiliation: Department of Health Sciences, University of York, York YO10 5DD, UK. Electronic address: l.han@york.ac.uk.
authors.forename: Lu
authors.initials: L
authors.lastname: Han
authors.affiliation: Department of Health Sciences, University of York, York YO10 5DD, UK. Electronic address: john.hutton@york.ac.uk.
authors.forename: John
authors.initials: J
authors.lastname: Hutton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004739:England / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000639:trends*; D055815:Young Adult
keywords: English hospitals; In-hospital mortality; Length of stay; Quicker and sicker; Readmissions