Reducing Length of Hospital Stay Does Not Increase Readmission Rates in Early-Stage Gastric, Colon, and Lung Cancer Surgical Cases in Japanese Acute Care Hospitals.
BACKGROUND
The Japanese government has worked to reduce the length of hospital stay by introducing a per-diem hospital payment system that financially incentivizes the timely discharge of patients. However, there are concerns that excessively reducing length of stay may reduce healthcare quality, such as increasing readmission rates. The objective of this study was to investigate the temporal changes in length of stay and readmission rates as quality indicators in Japanese acute care hospitals.


METHODS
We used an administrative claims database under the Diagnosis Procedure Combination Per-Diem Payment System for Japanese hospitals. Using this database, we selected hospitals that provided data continuously from July 2010 to March 2014 to enable analyses of temporal changes in length of stay and readmission rates. We selected stage I (T1N0M0) gastric, colon, and lung cancer surgical patients who had been discharged alive from the index hospitalization. The outcome measures were length of stay during the index hospitalization and unplanned emergency readmissions within 30 days after discharge.


RESULTS
From among 804 hospitals, we analyzed 42,585, 15,467, and 40,156 surgical patients for gastric, colon, and lung cancer, respectively. Length of stay was reduced by approximately 0.5 days per year. In contrast, readmission rates were generally stable at approximately 2% or had decreased slightly over the 4-year period.


CONCLUSIONS
In early-stage gastric, colon, and lung cancer surgical patients in Japan, reductions in length of stay did not result in increased readmission rates.
Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Susumu
S
Kunisawa
Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan.
Kiyohide
K
Fushimi
Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Yuichi
Y
Imanaka
D000368:Aged; D003106:Colon / Q000601:surgery; D003110:Colonic Neoplasms / Q000453:epidemiology / Q000601:surgery*; D004632:Emergency Medical Services; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007902:Length of Stay; D008168:Lung / Q000601:surgery; D008175:Lung Neoplasms / Q000453:epidemiology / Q000601:surgery*; D010359:Patient Readmission; D011787:Quality of Health Care; D013270:Stomach / Q000601:surgery; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000601:surgery*