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Use of severity-adjusted length of stay to modify physician practice patterns
P A Gross1, P E Yost-Cataruozolo, P DeMauro
1Hackensack Medical Center, NJ 07601.
Objective:
To compare inpatient length of stay among physicians by testing a new method for severity adjusting length of stay.
Design:
A retrospective validation study with prospective follow-up after an intervention.
Setting:
A 531-bed community teaching hospital.
Patients:
Three hundred randomly selected patients from the 30,861 patients discharged in 1990.
Intervention:
A physician with a significantly prolonged severity-adjusted length of stay was counseled and then monitored for three months.
Results:
The correlation between the number of comorbidities, complications, and manifestations of disease processes (CCMDPs) was R2 = 0.658, t = 23.96 (p = .001). One physician had an unusually high severity-adjusted length of stay, but lowered it after he was counseled and monitored for three months.
Conclusions:
The number of CCMDPs recorded on the hospital discharge abstract can be used as a severity index to adjust a patient's length of stay for illness severity. Using linear regression analysis, a picture of the severity-adjusted length of stay can be derived for physicians. Through counseling and monitoring, individual physicians' lengths of stay patterns may be reduced.