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Computer-generated informational messages directed to physicians: effect on length of hospital stay
S Shea1, R V Sideli, W DuMouchel
1Department of Medicine, Columbia University, New York, NY.
Insights
Computer-generated messages providing length of stay (LOS) data to physicians reduced hospital LOS by 3.2%. This intervention offers a cost-control strategy for hospitals managing diagnosis-related groups (DRGs).
Area of Science:
- Health Informatics
- Hospital Administration
- Clinical Decision Support
Background:
- Hospital payment models, such as diagnosis-related groups (DRGs), emphasize cost control.
- Length of stay (LOS) is a critical factor influencing hospital costs.
- Columbia-Presbyterian Medical Center (CPMC) experienced above-average LOS for many DRGs.
Purpose of the Study:
- To test if computer-generated informational messages to physicians can shorten hospital LOS.
- To evaluate the impact of providing LOS data on physician behavior and patient outcomes.
Main Methods:
- A randomized clinical trial was conducted at CPMC from June 1991 to April 1993.
- 7,109 patient admissions were assigned to an intervention group receiving LOS messages, and 6,990 to a control group.
- The intervention involved displaying average and current LOS for the patient's DRG within the clinical information system.
Main Results:
- The median LOS for all patients was 7 days.
- After adjusting for covariates, the intervention group showed a 3.2% shorter mean LOS compared to the control group (p = 0.022).
Conclusions:
- Computer-generated, patient-specific LOS information provided to physicians is associated with reduced hospital LOS.
- This approach can be a valuable tool for hospitals aiming to decrease costs and improve efficiency.
Objective:
With the advent of hospital payment by diagnosis-related group (DRG), length of stay (LOS) has become a major issue in hospital efforts to control costs. Because the Columbia-Presbyterian Medical Center (CPMC) has had above-average LOSs for many DRGs, the authors tested the hypothesis that a computer-generated informational message directed to physicians would shorten LOS.
Design:
Randomized clinical trial with the patient as the unit of randomization.
Setting And Study Population:
From June 1991 to April 1993, at CPMC in New York, 7,109 patient admissions were randomly assigned to an intervention (informational message) group and 6,990 to a control (no message) group.
Intervention:
A message giving the average LOS for the patient's admission or provisional DRG, as assigned by hospital utilization review, and the current LOS, in days, was included in the main menu for review of test results in the hospital's clinical information system, available at all nursing stations in the hospital.
Main Outcome Measure:
Hospital LOS.
Results:
The median LOS for study patients was 7 days. After adjustment for covariates including age, sex, payor, patient care unit, and time trends, the mean LOS in the intervention group was 3.2% shorter than that in the control group (p = 0.022).
Conclusion:
Computer-generated patient-specific LOS information directed to physicians was associated with a reduction in hospital LOS.