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Does Reducing Length of Stay Increase Rehospitalization of Medicare Fee-for-Service Beneficiaries Discharged to Skilled Nursing Facilities?

Authors

  • Mark A. Unruh PhD,

    Corresponding author
    1. Center for Healthcare Informatics and Policy, Weill Medical College, Cornell University, New York, New York
    2. Department of Public Health, Weill Cornell Medical College, New York, New York
    • Address correspondence to Dr. Mark A. Unruh, Weill Cornell Medical College, 425 East 61st Street, Suite 301, New York, NY 10065. E-mail: mau2006@med.cornell.edu

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  • Amal N. Trivedi MD, MPH,

    1. Department of Health Services, Policy and Practice, Alpert Medical School, Brown University, Providence, Rhode Island
    2. Research Enhancement Award Program, Providence Veterans Affairs Medical Center, Providence, Rhode Island
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  • David C. Grabowski PhD,

    1. Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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  • Vincent Mor PhD

    1. Department of Health Services, Policy and Practice, Alpert Medical School, Brown University, Providence, Rhode Island
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Abstract

Objectives

To analyze the relationship between length of stay and rehospitalization.

Design

Retrospective cohort study.

Setting

Six thousand five hundred thirty-seven hospitals nationwide from January 1999 through September 2005.

Participants

Medicare fee-for-service beneficiaries associated with 2,101,481 hospitalizations.

Measurements

Thirty-day rehospitalization derived from Medicare hospital claims using the implementation of Medicare's post-acute care transfer policy as a quasi-experiment.

Results

Medicare's post-acute care transfer policy led to immediate declines in length of stay. A 1-day decrease in length of stay was associated with an absolute increase in 30-day rehospitalization of 1.56 percentage points (95% confidence interval (CI) = 0.30–2.82) for acute myocardial infarction (AMI) with major complications and 0.81 percentage points (95% CI = 0.03–1.60) for kidney infection or urinary tract infection (UTI) without major complications. Individuals hospitalized for AMI without major complications, heart failure, or kidney infection or UTI with major complications had no increase in 30-day rehospitalization.

Conclusion

A 1-day reduction in hospital length of stay was not consistently associated with a higher rate of rehospitalization.

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