Factors affecting length of stay in teaching hospitals of a middle-income country

Authors

  • Soudabeh Vatankhah Associate Professor of Health Services Management Department, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran

Keywords:

Length of stay, Clinical and nonclinical factors, Hospital performance, Teaching hospital

Abstract

Introduction: The length of stay (LOS) in hospitals is a widely used and important criteria for evaluating hospital performance. The aim of this study was to determine factors affecting LOS in teaching hospitals of Qazvin Providence.

Methods: In this cross-sectional study, patients’ health records were randomly selected from archives in teaching hospitals of Qazvin in 2013. Data were collected through a data entry form and were analyzed using Kolmogorov–Smirnov, Kruskal–Wallis, and Mann–Whitney U tests at the significant level of 0.05.

Results: The mean of hospital LOS was 5.45 ± 6.14 days. Age, employment, marital status, history of previous admission, patient condition at discharge, method of payment, and type of treatment had an impact on LOS (p<0.05). Other factors, including gender, place of residence, and type of admission, did not affect LOS.

Conclusion: Because hospitals consume a perceptible part of resources in a health system, controlled and optimized use of its resources help to save a lot. Therefore, this study showed many clinical and nonclinical factors affect LOS in evaluating these factors, which may reduce inappropriate hospital stays and decrease costs.

References

Asefzadeh S. Hospital Management and Research. Qazvin: Qazvin University of medical siences. 2010.

Atienza N, García-Heras J, Muñoz-Pichardo JM, Villa R. An application of mixture distributions in

modelization of length of hospital stay. Stat Med. 2008; 27(9): 1403-20. doi: 10.1002/sim.3029. PMID:

Ravangard R, Arab M, Zeraati H, Rashidian A, Akbarisari A, Mostaan F. Patients' length of stay in women

hospital and its associated clinical and non-clinical factors, tehran, iran. Iran Red Crescent Med J. 2011;

(5): 309-15. PMID: 22737486, PMCID: PMC3371979.

Schoen C, Osborn R, How SK, Doty MM, Peugh J. In chronic condition: experiences of patients with

complex health care needs, in eight countries, 2008. Health Aff (Millwood). 2009; 28(1): 1-16. doi:

1377/hlthaff.28.1.w1. PMID: 19008253.

Siskou O, Kaitelidou D, Economou C, Kostagiolas P, Liaropoulos L. Private expenditure and the role of

private health insurance in Greece: status quo and future trends. Eur J Health Econ. 2009; 10(4): 467-74.

doi: 10.1007/s10198-009-0164-3. PMID: 19593628.

Mawajdeh S, Hayajneh Y, Al-Qutob R. The effect of type of hospital and health insurance on hospital

length of stay in Irbid, North Jordan. Health Policy Plan. 1997; 12(2): 166-72. PMID: 10168199.

Haqgoshayi E, Narimani M. Day hospital is a model to reduce the length of stay in hospital patients. Health

Management. 2012; 14(46): 21-30.

Bastani P, Vatankhah S, Salehi M. Performance ratio analysis: a national study on Iranian hospitals

affiliated to Ministry of Health and Medical Education. Iranian J Publ Health. 2013; 42(8): 876-82. PMID:

, PMCID: PMC4441919.

Clarke A. Why are we trying to reduce length of stay? Evaluation of the costs and benefits of reducing time

in hospital must start from the objectives that govern change. Qual Health Care. 1996; 5(3): 172-9. PMID:

, PMCID: PMC1055402.

Tiessen J, Kambara H, Sakai T, Kato K, Yamauchi K, McMillan C. What causes international variations in

length of stay: A comparative analysis for two inpatient conditions in Japanese and Canadian hospitals.

Health Serv Manage Res. 2013; 26(2-3): 86-94. doi: 10.1177/0951484813512287. PMID: 25595005.

Yin J, Lurås H, Hagen TP, Dahl FA. The effect of activity-based financing on hospital length of stay for

elderly patients suffering from heart diseases in Norway. BMC Health Serv Res. 2013; 13(1): 172. doi:

1186/1472-6963-13-172. PMID: 23651910, PMCID: PMC3651263.

Al-Jadid MS, Robert AA. Determinants of length of stay in an inpatient stroke rehabilitation unit in Saudi

Arabia. Saudi Med J. 2010; 31(2): 189-92. PMID: 20174737.

Huang PY, Lin MZ, Wen JP, Li XJ, Shi XL, Zhang HJ, et al. Correlation of early postoperative blood

glucose levels with postoperative complications, hospital costs, and length of hospital stay in patients with

gastrointestinal malignancies. Endocrine. 2015; 48(1): 187-94. doi: 10.1007/s12020-014-0291-1. PMID:

Nussbaum DP, Penne K, Stinnett SS, Speicher PJ, Cocieru A, Blazer DG 3rd, et al. A standardized care

plan is associated with shorter hospital length of stay in patients undergoing pancreaticoduodenectomy. J

Surg Res. 2015; 193(1): 237-45. doi: 10.1016/j.jss.2014.06.036. PMID: 25062813.

Lee S, O’Neill A, Park J, Scully L, Shenassa E. Health Insurance Moderates the Association Between

Immigrant Length of Stay and Health Status. J Immigr Minor Health. 2012; 14(2): 345-9. PMID:

Singh CH, Ladusingh L. Inpatient length of stay: a finite mixture modeling analysis. Eur J Health Econ.

; 11(2): 119-26. doi: 10.1007/s10198-009-0153-6. PMID: 19430985.

Lim A, Tongkumchum P. Methods for analyzing hospital length of stay with application to inpatients dying

in Southern Thailand. Global Journal of Health Science. 2009; 1(1): 27. doi: 10.5539/gjhs.v1n1p27.

Rafiee M, Mohammad T, Behboodyan J. Comparison of different modeling strategies length of stay of

patients hospitalized in teaching hospitals in Shiraz. Tabriz Medical University Journal. 2006; 2(29): 43-51.

Toyabe S, Cao P, Abe T, Uchiyama M, Akazawa K. Impact of Sociocultural factors on Hospital Length of

stay in children with nephritic syndrome in Japan. Health Policy. 2006; 76(3): 259-65. doi:

1016/j.healthpol.2005.06.008. PMID: 16026888.

Arab M, Zarei A, Rahimi A, Rezaiean F, Akbari F. Analysis of factors affecting length of stay in public

hospitals in Lorestan Province, Iran. Hakim Research Journal. 2010; 12(4): 27-32.

Naghavi M, jamshidi H. Utilization of Health services in Iran. Tehran: Ministry of Health press. 2003.

Salesi M. Study of patient's length of stay and its associated factors in Tehran Shariati Hospital's surgical

units using Multiple Cox Proportional Hazards Model Tehran. Tehran: Tehran University of Medical

Sciences. 2005.

Gholivahidi R, Kooshavar H, khodayari R. The Study of patients length of stay and its Associated factors

in Tabriz Shahid Madani Cardiovascular Hospital. Journal of Health Administration. 2006; 9(25): 63-9.

Sepehri A, Simpson W, Sarma S. The influence of health insurance on hospital admission and length of

stay-The case of Vietnam. Soc Sci Med. 2006; 63(7): 1757-70. doi: 10.1016/j.socscimed.2006.04.029.

PMID: 16766108.

Nietert PJ, Silverstein MD, Silver RM. Hospital admissions, length of stay, charges, and in-hospital death

among patients with systemic sclerosis. J Rheumatol. 2001; 28(9): 2031-7. PMID: 11550971.

Freitas A, Silva-Costa T, Lopes F, Garcia-Lema I, Teixeira-Pinto A, Brazdil P, et al. Factors influencing

hospital high length of stay outliers. BMC Health Serv Res. 2012; 12(1): 265. doi: 10.1186/1472-6963-12- 265. PMID: 22906386, PMCID: PMC3470984.

Bolden L, Wicks MN. Length of stay, admission types, psychiatric diagnoses, and the implications of

stigma in African Americans in the nationwide inpatient sample. Issues in Mental Health Nursing. 2005;

(10): 1043-59. doi: 10.1080/01612840500280703. PMID: 16283998.

Gohari M, Vahabi N, Moghadamifard Z. Semi-parametric Cox regression for factors affecting

hospitalization length. Daneshvar Pezeshki. 2012; 19(99): 23-30.

Brasel KJ, Lim HJ, Nirula R, Weigelt JA. Length of stay: an appropriate quality measure? Archives of

Surgery. 2007; 142(5): 461-5. doi: 10.1001/archsurg.142.5.461. PMID: 17515488.

Mainous A, Diaz V, Everett C, Knoll M. Impact of insurance and hospital ownership on hospital length of

stay among patients with ambulatory care-sensitive conditions. Ann Fam Med. 2011; 9(6): 489-95. doi:

1370/afm.1315. PMID: 22084259, PMCID: PMC3252189.

Liu Y, Phillips M, Codde J. Factors influencing patients' length of stay. Aust Health Rev. 2001; 24(2): 63- 70. doi: 10.1071/AH010063. PMID: 11496473.

Teke K, Kisa A, Demir C, Ersoy K. Appropriateness of admission and length of stay in a Turkish Military

Hospital. J Med Syst. 2004; 28(6): 653-63. PMID: 15615293.

Jiménez R, López L, Dominguez D, Fariñas H. Difference between observed and predicted length of stay

as an indicator of inpatient care inefficiency. International Journal for Quality in Health Care. 1999; 11(5):

-84. PMID: 10561028.

Published

2022-03-08