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Updated: Jan 15, 2026
Experimental Model to Evaluate Resolution of Pneumonia
Published on: February 17, 2023
A Comparative Evaluation of Prolonged Hospitalization in Japanese Hospitals: Analysis Based on a Risk-Adjusted
Ryo Onishi1, Yosuke Hatakeyama, Kunichika Matsumoto
1Author Affiliations: Department of Social Medicine, Faculty of Medicine, Toho University, Tokyo, Japan (Drs Onishi, Hatakeyama, Matsumoto, Hirata, Seto, and Hayashi, Prof Hasegawa) and Department of Nursing, Faculty of Health Sciences, Tokyo Kasei University, Saitama, Japan (Dr Kitazawa).
Background And Objectives:
Prolonged hospitalization (PH) increases the burden on patients and health care finances. In Japan, health policy initiatives have aimed to reduce the length of hospital stays (LOS). Previous studies have suggested that LOS is influenced by patient characteristics and the quality of hospital care. This retrospective observational study aimed to elucidate differences across hospitals in the extent to which prolonged hospitalization is controlled, through the calculation of a risk-adjusted indicator.
Methods:
This study included inpatients 15 years of age and older diagnosed with pneumonia from 2014 to 2022. Hospitalization exceeding the average duration was defined as PH. We developed an RPH ratio indicator using Japanese administrative claim data in 2014-2022 and each period (2014-2016, 2017-2019, 2020-2022). The RPH ratio was calculated by the actual number of PH patients and the expected number of PH patients. The expected number of PH patients was determined using logistic regression analysis with risk-adjusted variables.
Results:
A total of 36,417 patients with pneumonia from 39 hospitals were included. The mean LOS was 19.2 days. The PH rate was 41.7%. The mean (± standard deviation) RPH ratio was 100.5 ± 21.4, ranging from 47.9 to 153.3, indicating a 3.2-fold difference between the minimum and maximum ratios. We found a significant positive relationship between changes in the ratio for each consecutive period.
Conclusion:
This study revealed significant variations among hospitals in the quality of LOS management and identified a notable trend in RPH ratios. Hospitals with high RPH ratios were likely to yield similar results in subsequent periods, emphasizing the importance of supporting hospitals.
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