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Shorter hospital stays don't mean worse care: study

By Andrew M. Seaman

NEW YORK (Reuters Health) - U.S. Veterans Affairs hospitals were able to reduce their patients' length of stay without increasing the number of people who needed to be readmitted later on, according to a new study.

"As hospitals became more efficient there was this growing concern that we were discharging patients - as some would say - sicker and quicker," said the study's lead author Dr. Peter Kaboli.

"In fact, we found just the opposite," said Kaboli, who works at the Iowa City VA Health Care System.

According to the researchers, who published their findings in the Annals of Internal Medicine, hospitals are under pressure to cut the amount of time their patients spend there.

It's a goal that benefits everyone, they write, because getting patients out of the hospital faster reduces the risk of infection and also cuts costs.

But some worry that discharging patients earlier increases the chance they will return to the hospital for additional care. Such readmissions cost the U.S. Medicare program an estimated $17 billion every year, according to a 2009 study.

What's more, on October 1 of this year, the Centers for Medicare and Medicaid Services started using readmission rates and patient outcomes as a way to determine how much money hospitals should be paid.

For the new study, Kaboli and his colleagues, wanted to see if shorter stays throughout the VA's 129 centers meant more patients returned to the hospital within 30 days of discharge.

Using the VA's electronic medical records, the researchers analyzed over 4 million patients' records from between 1997 and 2010.

They found the average hospital stay decreased from about 5.5 days at the beginning of the study to about 4 days at the end.

As for the number of patients who returned to the hospital within 30 days of their discharge, the researchers found that rate fell by 3 percentage points, from 16.5 percent in 1997 to 13.8 percent in 2010.

"I felt going into this that (length of stay) wouldn't make a difference, but showing that it reduces readmission was a positive and reassuring find," said Kaboli.

QUALITY MEASURES

The researcher found, however, that there was a point where a short length of stay was linked to more patients being readmitted. Hospitals with lengths of stay at least one day shorter than the average ended up seeing an increase in readmissions.

There were also concerns that some of the patients died at home instead of returning to the hospital. But the researchers found that the number of people dying within 90 days of leaving the hospital also decreased during those 14 years.

"For patients, we've been able to take care of them more efficiently, with better quality and reducing mortality rates all at the same time," said Kaboli.

But Morris Weinberger, of Duke University, and Dr. Eugene Oddone, of the University of North Carolina at Chapel Hill question whether readmission rates are a good measure of a hospital's quality.

They write in an editorial accompanying the new study that a number of factors outside of a typical doctor's control can influence the risk of a person being readmitted to the hospital.

In October, a study suggested that a person's employment status, living situation and education are all linked to their risk of being readmitted to the hospital (see Reuters Health article of October 19, 2012 here: http://reut.rs/Z7uCy9).

Dr. Manesh Patel, an assistant professor of cardiology at Duke University in Durham, told Reuters Health that this study shows that the VA system improved in areas that patients care about.

"The good news here is that there seems to be a linkage... Some of these measures that we're using might be reasonable measures," said Patel, who was not involved in the new research but has studied hospital readmissions.

Kaboli added that it's also important to not just focus on getting patients out of the hospital. It's also important to respect their wishes.

"This is a team effort. (Patients) need to communicate their goals and wishes, and have these conversations with the nurse and doctors so everyone is working toward a common goal," he said.

SOURCE: http://bit.ly/SLWzwm and http://bit.ly/SMrvg5 Annals of Internal Medicine, online December 17, 2012.

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