Shorter Length of Stay May Not Mean Higher Readmission Rates

Length of stay (LOS) in hospitals may drop, but it doesn’t necessarily lead to higher readmission rates, according to a study by Kyoto University researchers.

In Japan, the researchers say, acute care hospital stays are longer than in other developed countries but have shortened over the past decade—mainly due to the Diagnosis Procedure Combination Per-Diem Payment System (DPC/PDPS). Under that system, introduced in 2003, hospital reimbursements from insurers reduce as LOS increases for individual patients.

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Concerns that excessive reductions might worsen the quality of health care led the researchers to investigate what the last 10 years of DPC/PDPS have meant for early-stage cancer surgical patients.

They analyzed 4 years of data from 804 hospitals on 42,585 surgical patients with gastric cancer, 40,156 with lung cancer, and 15,467 with colon cancer, comparing LOS with unplanned readmissions within 30 days.

They found LOS was reduced—although slightly—by about 0.5 d/y. Mean overall LOS for gastric cancer patients dropped from 21.85 days to 19.89; for lung cancer patients, from 15.61 to 14.25; for colon cancer patients, from 18.70 to 17.18.

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However, unplanned emergency readmission rates remained relatively stable at about 2% or declined slightly. Readmission rates were significantly lower only for lung cancer patients; declines were not significant for the other groups.

Both preoperative and postoperative LOS also decreased during the study period. In particular, the researchers note, improvements in postoperative care may have shortened LOS. They also suggest that downward trends reflect improvements due to better medical techniques, procedure choices, and advances in clinical pathways.

Source:
Kunisawa S, Fushimi K, Imanaka Y. PLoS One. 2016;11(11): e0166269.
doi: 10.1371/journal.pone.0166269.