Factors Influencing Length Of Stay, Time To Resolution Of Morbidity, And Cost Of Patient Care: A Comparative Retrospective Study Of Short-Stay And Long-Stay Patients Hospitalized For Simple Pneumonia (Drg 89 And 90)

摘要

Pneumonia is one of the leading causes of hospitalization in the United States. Guidelines for the management of pneumonia have been shown to reduce the length of hospital stay without compromising the quality of medical care. The authors sought to investigate the reasons for prolonged hospital stay and increased cost among patients who were hospitalized for more than 5 days and had a discharge diagnosis of simple pneumonia (Diagnosis-Related Group [DRG] 89 and DRG 90). In 1998, there were 977 patients with discharge diagnoses of simple pneumonia with and without complications or comorbidities (DRG 89, DRG 90). A total of 276 patients had a length of hospital stay (LOS) greater than 5 days (long stay; LS). One of four charts was selected from this group by chronological order of admission. For the case matching, charts were selected from those patients whose LOS was less than 5 days (short stay; SS). Patients with LOS equal to 5 days were excluded from the analysis. Data for comorbid-ity, severity of illness, laboratory findings, time to resolution of morbidity (TRM), LOS, antimicrobial use, complications, 30-day readmissions, and admitting physicians were collected. The patients were classified into different risk groups using severity index scores. Sixty-six charts from the LS group and an equal number of charts from the SS group were reviewed. Age and sex were equally distributed between the two groups. The difference between TRM and discharge was significantly longer in both the lower-risk (4.47 days for LS and 1.37 days for SS) and the high-risk groups (5.92 days for LS and 1.55 days for SS). The LS group, despite resolution of symptoms, stayed in the hospital disproportionately longer (4 days) than the SS group. Individual physician decision making was the major factor influencing this prolonged stay. Patients who were residents of extended-care facilities (ECF) tended to stay longer and had a longer mean TRM. Use of a combination of levofloxacin with a beta-lactam agent did not show an advantage over treatment with levofloxacin alone. The mean difference in the cost of care of these two comparable risk groups of patients was