Ghosh Arnab K, Unruh Mark A, Soroka Orysya, Shapiro Martin
Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA.
Department of Population Health Sciences, Weill Cornell Medical College, Cornell University, New York, NY, USA.
Health Serv Res Manag Epidemiol. 2021 Jul 29;8:23333928211035581. doi: 10.1177/23333928211035581. eCollection 2021 Jan-Dec.
Length of stay (LOS), a metric of hospital efficiency, differs by race/ethnicity and socioeconomic status (SES) and longer LOS is associated with adverse health outcomes. Historically, projects to improve LOS efficiency have yielded LOS reductions by 0.3 to 0.7 days per admission.
To assess differences in average adjusted length of stay (aALOS) over time by race/ethnicity, and SES stratified by discharge destination (home or non-home).
Data were obtained from 2009-2014 Healthcare Cost and Utilization Project State Inpatient Datasets for New York, New Jersey, and Florida. Multivariate generalized linear models were used to examine trends in aALOS differences by race/ethnicity, and by high vs low SES patients (defined first vs fourth quartile of median income by zip code) controlling for patient, disease and hospital characteristics.
For those discharged home, racial/ethnic and SES aALOS differences remained stable from 2009 to 2014. However, among those discharged to non-home destinations, Black vs White aALOS differences increased from 0.21 days in Q1 2009, (95% confidence interval (CI): 0.13 to 0.30) to 0.32 days in Q3 2013, (95% CI: 0.23 to 0.40), and for low vs high SES patients from 0.03 days in Q1 2009 (95% CI: -0.04 to 0.1) to 0.26 days, (95% CI: 0.19 to 0.34). Notably, for patients not discharged home, racial/ethnic and SES aALOS differences increased and persisted after Q3 2011, coinciding with the introduction of the Affordable Care Act (ACA).
Further research to understand the ACA's policy impact on hospital efficiencies, and relationship to racial/ethnic and SES differences in LOS is warranted.
住院时间（LOS）作为医院效率的一项指标，因种族/族裔和社会经济地位（SES）而异，住院时间延长与不良健康结局相关。从历史上看，旨在提高住院时间效率的项目使每次住院的住院时间减少了0.3至0.7天。
评估按种族/族裔以及按出院目的地（回家或非回家）分层的SES划分的平均调整住院时间（aALOS）随时间的差异。
数据来自2009 - 2014年纽约、新泽西和佛罗里达州的医疗保健成本和利用项目州住院数据集。使用多变量广义线性模型来研究按种族/族裔以及高SES与低SES患者（根据邮政编码定义为收入中位数的第一四分位数与第四四分位数）划分的aALOS差异趋势，并控制患者、疾病和医院特征。
对于那些出院回家的患者，2009年至2014年期间，种族/族裔和SES的aALOS差异保持稳定。然而，在那些出院到非回家目的地的患者中，黑人与白人的aALOS差异从2009年第一季度的0.21天（95%置信区间（CI）：0.13至0.30）增加到2013年第三季度的0.32天（95%CI：0.23至0.40），低SES与高SES患者的差异从2009年第一季度的0.03天（95%CI： - 0.04至0.1）增加到0.26天（95%CI：0.19至0.34）。值得注意的是，对于未出院回家的患者，种族/族裔和SES的aALOS差异在2011年第三季度之后增加并持续存在，这与《平价医疗法案》（ACA）的出台相吻合。
有必要进行进一步研究，以了解ACA对医院效率的政策影响，以及与住院时间方面种族/族裔和SES差异的关系。
