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New York City Health and Hospitals (HHC) hospitals have different patient case mix than non-public hospitals. Patients in HHC facilities experience longer average lengths of stay (ALOS) even within the same diagnosis-related groups (DRGs).
Area of Science:
- Health Services Research
- Hospital Administration
- Public Health Policy
Background:
- Public hospitals in New York City (HHC hospitals) serve a unique patient population.
- Understanding differences in case mix and length of stay is crucial for resource allocation and quality improvement.
Purpose of the Study:
- To compare the case mix of HHC hospitals with non-HHC hospitals.
- To determine how case mix differences affect average length of stay (ALOS).
- To identify factors beyond case mix that influence ALOS.
Main Methods:
- Utilized Diagnosis-Related Groups (DRGs) to define and compare patient case mix.
- Matched public (HHC) and non-public (non-HHC) hospitals for comparison.
- Analyzed factors contributing to differences in average length of stay (ALOS).
Main Results:
- Significant differences in case mix exist between HHC and non-HHC hospitals, with HHC having more psychiatric and chemical dependence cases and fewer surgical cases.
- HHC hospitals have a more concentrated case load within fewer DRGs.
- Despite treating DRGs with shorter ALOS, patients in HHC facilities have a longer length of stay (LOS) by over one day within the same DRG.
- Differences in payor type, primary diagnosis, and a higher percentage of outlier patients contribute to longer LOS in HHC hospitals.
Conclusions:
- Case mix alone does not fully explain the longer length of stay in HHC hospitals.
- Factors such as patient demographics, payor mix, and clinical complexity (outlier status) significantly impact ALOS in public hospitals.
- Targeted interventions addressing these factors may help reduce LOS in HHC facilities.
Abstract:
The 12 acute care public hospitals in New York City (HHC hospitals) are compared with a matched group of nonpublic hospitals (non-HHC hospitals). The following questions are considered: using DRGs to define case mix, how does the case mix of HHC and non-HHC hospitals differ; to what extent do differences in case mix account for differences in average length of stay (ALOS); can factors other than case mix be identified that may explain differences in ALOS? Although about one half of the 20 most prevalent DRGs are similar in both types of institutions, there are clear case mix differences. The higher percentage of abortion, psychiatric, and chemical dependence discharges and the lower prevalence of surgery in HHC hospitals contribute to this difference. The case load is more concentrated in fewer DRGs in HHC hospitals. HHC hospitals treat more patients in DRGs with a shorter ALOS, but, on the average, patients in the same DRG stay more than 1 day longer in HHC facilities. To some extent, this longer LOS can be explained by differences in payor type, primary diagnosis within a DRG, and, most important, in the percentage of outlier patients.