The Correlation of Hospital Operational Efficiency and Average Length of Stay in China: A Study Based on Provincial Level Data

Objective: To measure the hospital operation efficiency, study the correlation between average length of stay and hospital operation efficiency, analyze the importance of shortening average length of stay to the improvement of the hospital operation efficiency and put forward relevant policy suggestion. Methods: Based on China provincial panel data from 2003 to 2012, the hospital operation efficiencies are calculated using Super Efficiency Data Envelopment Analysis model, and the correlation between average length of stay and hospital operation efficiency is tested using Spearman rank correlation coefficient test. Results: From 2003 to 2012, the average of national hospital operation efficiency was increasing slowly and the hospital operations were inefficient in most of the areas. The national hospital operation efficiency is negatively correlated to the average length of stay. Conclusion: Measures should be taken to set average length of stay in a scientific and reasonable way, improve social and economic benefits based on the improvement of efficiency.

Recent Developments in Health Care Utilization at the Community Level

Recent developments in health care have changed hospital utilization at the community level. This study provided examples of these changes in the metropolitan area of Syracuse, New York. The study demonstrated that percent differences in discharges between the two time periods for both services changed little. For adult medicine, percent differences ranged between 16.5 and 18.0 percent while percent differences in adult surgery ranged from 23.25 to 24.93 percent. This information suggested that reductions in discharges during the five year period had stabilized. Most of these changes were associated with the movement of patients from inpatient to ambulatory care services. The largest numbers of these patients were associated with orthopedic surgery. They resulted from the movement of these patients who were at low severity of illness to ambulatory care settings. The study also identified increases in hospital lengths of stay for adult medicine and adult surgery between January-September 2019 and 2023 in the Syracuse hospitals. Adult medicine stays increased by 23.6 percent, from 4.84 to 5.98 days. Adult surgery stays increased by 25.5 percent, from 5.41 to 6.79 days.

Addressing hospital length of stay outlier patients: A community wide approach

Length of stay outlier patients, who remain in hospitals for extended periods of time, is an important challenge to the improvement of health care efficiency. This study identified outlier patients and programs to address them in the metropolitan area of Syracuse, New York. It demonstrated that, during 2013, outlier patients accounted for 2.4 percent of adult medicine discharges and an excess average daily census of 53.3 patients in the Syracuse hospitals. During 2013, outlier patients accounted for 4.3 percent of adult surgery discharges and an excess average daily census of 44.1 patients. In two studies, the Syracuse hospitals identified the need for multiple intravenous therapy, extensive wound care, and total parenteral nutrition in the community, as major causes of outlier stays in hospitals. Each of the hospitals has developed a program with a long term care facility to address these needs. Efforts to address outlier lengths of stay are also focusing on Potentially Preventable Complications in Syracuse. The mean length of stay for inpatients with post admissions complications was almost three times the stay for the medical/surgical population during 2013.

Cost analysis of radical resection of malignant breast tumors under the China Healthcare Security Diagnosis Related Groups payment system

BACKGROUND Breast cancer is one of the most common malignant tumors in women worldwide and poses a severe threat to their health.Therefore,this study examined patients who underwent breast cancer surgery,analyzed hospitalization costs and structure,and explored the impact of China Healthcare Security Diagnosis Related Groups(CHS-DRG)management on patient costs.It aimed to provide medical institutions with ways to reduce costs,optimize cost structures,reduce patient burden,and improve service efficiency.AIM To study the CHS-DRG payment system’s impact on breast cancer surgery costs.METHODS Using the CHS-DRG(version 1.1)grouping criteria,4073 patients,who underwent the radical resection of breast malignant tumors from January to December 2023,were included in the JA29 group;1028 patients were part of the CHS-DRG payment system,unlike the rest.Through an independent sample t-test,the length of hospital stay as well as total hospitalization,medicine and consumables,medical,nursing,medical technology,and management expenses were compared.Pearson’s correlation coefficient was used to test the cost correlation.RESULTS In terms of hospitalization expenses,patients in the CHS-DRG payment group had lower medical,nursing,and management expenses than those in the diagnosis-related group(DRG)non-payment group.For patients in the DRG payment group,the factors affecting the total hospitalization cost,in descending order of relevance,were medicine and consumable costs,consumable costs,medicine costs,medical costs,medical technology costs,management costs,nursing costs,and length of hospital stay.For patients in the DRG nonpayment group,the factors affecting the total hospitalization expenses in descending order of relevance were medicines and consumable expenses,consumable expenses,medical technology expenses,the cost of medicines,medical expenses,nursing expenses,length of hospital stay,and management expenses.CONCLUSION The CHS-DRG system can help control and reduce unnecessary medical expenses by controlling medicine costs,medical consumable costs,and the length of hospital stay while ensuring medical safety.

Surgical treatment of liver cancer and pancreatic cancer under the China Healthcare Security Diagnosis Related Groups payment system

BACKGROUND Data from the World Health Organization’s International Agency for Research on Cancer reported that China had the highest prevalence of cancer and cancer deaths in 2022.Liver and pancreatic cancers accounted for the highest number of new cases.Real-world data(RWD)is now widely preferred to traditional clinical trials in various fields of medicine and healthcare,as the traditional research approach often involves highly selected populations and interventions and controls that are strictly regulated.Additionally,research results from the RWD match global reality better than those from traditional clinical trials.AIM To analyze the cost disparity between surgical treatments for liver and pancreatic cancer under various factors.METHODS This study analyzed RWD 1137 cases within the HB1 group(patients who underwent pancreatectomy,hepatectomy,and/or shunt surgery)in 2023.It distinguished different expenditure categories,including medical,nursing,technical,management,drug,and consumable costs.Additionally,it assessed the contribution of each expenditure category to total hospital costs and performed cross-group comparisons using the non-parametric Kruskal–Wallis test.This study used the Steel–Dwass test for post-hoc multiple comparisons and the Spearman correlation coefficient to examine the relationships between variables.RESULTS The study found that in HB11 and HB13,the total hospitalization costs were significantly higher for pancreaticoduodenectomy than for pancreatectomy and hepatectomy.Although no significant difference was observed in the length of hospital stay between patients who underwent pancreaticoduodenectomy and pancreatectomy,both were significantly longer than those who underwent liver resection.In HB15,no significant difference was observed in the total cost of hospitalization between pancreaticoduodenectomy and pancreatectomy;however,both were significantly higher than those in hepatectomy.Additionally,the length of hospital stay was significantly longer for patients who underwent pancreaticoduodenectomy than for those who underwent pancreatectomy or liver resection.CONCLUSION China Healthcare Security Diagnosis Related Groups payment system positively impacts liver and pancreatic cancer surgeries by improving medical quality and controlling costs.Further research could refine this grouping system and ensure continuous effectiveness and sustainability.

Disparities in colonoscopy utilization for lower gastrointestinal bleeding in rural vs urban settings in the United States

BACKGROUND Lower gastrointestinal bleeds(LGIB)is a very common inpatient condition in the United States.Gastrointestinal bleeds have a variety of presentations,from minor bleeding to severe hemorrhage and shock.Although previous studies investigated the efficacy of colonoscopy in hospitalized patients with LGIB,there is limited research that discusses disparities in colonoscopy utilization in patients with LGIB in urban and rural settings.AIM To investigate the difference in utilization of colonoscopy in lower gastrointestinal bleeding between patients hospitalized in urban and rural hospitals.METHODS This is a retrospective cohort study of 157748 patients using National Inpatient Sample data and the Healthcare Cost and Utilization Project provided by the Agency for Healthcare Research and Quality.It includes patients 18 years and older hospitalized with LGIB admitted between 2010 and 2016.This study does not differentiate between acute and chronic LGIB and both are included in this study.The primary outcome measure of this study was the utilization of colonoscopy among patients in rural and urban hospitals admitted for lower gastrointestinal bleeds;the secondary outcome measures were in-hospital mortality,length of stay,and costs involved in those receiving colonoscopy for LGIB.Statistical analyses were all performed using STATA software.Logistic regression was used to analyze the utilization of colonoscopy and mortality,and a generalized linear model was used to analyze the length of stay and cost.RESULTS Our study found that 37.9%of LGIB patients at rural hospitals compared to approximately 45.1%at urban hospitals received colonoscopy,(OR=0.730,95%CI:0.705-0.7,P>0.0001).After controlling for covariates,colonoscopies were found to have a protective association with lower inhospital mortality[OR=0.498,95%CI:0.446-0.557,P<0.0001],but a longer length of stay by 0.72 d(95%CI:0.677-0.759 d,P<0.0001)and approximately$2199 in increased costs.CONCLUSION Although there was a lower percentage of LGIB patients that received colonoscopies in rural hospitals compared to urban hospitals,patients in both urban and rural hospitals with LGIB undergoing colonoscopy had decreased in-hospital mortality.In both settings,benefit came at a cost of extended stay,and higher total costs.

Estimating the Potential for Reduction of Hospital Capacity at the Community Level

This study estimated the potential impact of the nationwide shift from inpatient to outpatient care in the hospitals of Syracuse, New York, a small metropolitan area with a relatively stable population. The study employed the 3MTM All Patients Refined Diagnosis Group Severity of Illness system to identify inpatients and related utilization with the greatest potential for movement from inpatient to outpatient settings. The study data suggested that the development of additional ambulatory care capacity in Syracuse could support the reduction of an average daily census of approximately 60 - 125 patients with low severity of illness, excluding readmissions. The study data also identified the potential for shifting an average daily census of approximately 9 - 19 patients who were readmitted to hospitals within 30 days of their initial admissions from inpatient to outpatient care. The study data also identified the potential for reduction of an average daily census of approximately 20 - 70 adult medicine and adult surgery patients through continued initiatives for inpatient length of stay reduction. The impact of initiatives in each of these areas could result in a reduction of the combined average daily adult medicine and adult surgery census of the Syracuse hospitals from approximately 90 to 215 patients. This would amount to between 8 and 20 percent of the current inpatient census for adult medicine and adult surgery. These data suggest that planning for initiatives such as ambulatory care development and reduction of readmissions should also include evaluation of their impact on inpatient acute care and related services.

上海市某医院股骨头坏死病人不适当住院日研究

入院及住院日适当性评价方案是基于医疗和技术标准的、独立于各病种的评价工具,在诊断不明确或不正确的情况下也能使用。评价住院日是否适当的方法是对每份病案进行回溯性评价,对病人住院的每一天进行考察,如果该天符合标准中的某一项,则该天的住院是合适的,如果不符合任何一项,则是不合适的。对2007年全年股骨头坏死出院病人,共计351例进行住院日适当性评价。

不适当住院日研究综述

入院及住院日适当性评价方案是基于医疗和技术标准的、独立于各病种的评价工具,在诊断不明确或不正确的情况下也能使用。它分为医疗服务、护理/生命保障服务和病人状况三大部分,最初共有27项标准。评价住院日是否适当的方法是对每份病案进行回溯性回顾,对病人住院的每一天进行考察,如果该天符合标准中的某一项,则该天的住院是合适的,如果不符合任何一项,则是不合适的。