Length of hospital stay for cerebrovascular disease in the United States: Professional Activity Study, 1963-1991.

OBJECTIVE

To assess the temporal and spatial variation in length of hospital stay for cerebrovascular disease in the United States over three decades.

DESIGN

Age-, region-, and stroke type-specific length-of-hospital-stay data for nearly 4 million patients admitted with cerebrovascular disease were obtained for the Professional Activity Study of the Commission on Professional and Hospital Activities for the period 1963-1991.

MAIN OUTCOME MEASURE

Weighted averages and standard errors of length of stay were calculated for aggregate diagnosis groups within the category of cerebrovascular disease. Averages were age-adjusted by the direct method.

RESULTS

Average length of hospital stay declined from a peak of 18 days in 1967 to 8 days in 1991. The decline accelerated sharply from 1982 to 1986 coincident with implementation of the Medicare prospective payment system. Similar declines were observed within each age group, each cerebrovascular disease diagnosis group, and each census region. There were marked and persistent differences in average length of stay between regions, with longer stays in the Northeast and shorter stays in the West. The large interregional variation was not explained by differences in age or cerebrovascular disease diagnoses.

CONCLUSIONS

Implementation of the Medicare prospective payment system produced a marked decline in length of hospital stay for cerebrovascular disease, which was superimposed on a preexisting, but slower, decline. Much of the marked persistent interregional variation probably results from persistent widespread variation in patient management.