The effect of community of discharge on length of stay for unplanned hospitalizations: An indicator of community care integration?

Abstract

Objective: Adjusted hospital length of stay (LOS), widely used to benchmark hospital efficiency, does not account for community-driven variation. We estimate the extent to which community affects LOS for unplanned hospitalizations, whether this differs by complex needs, and identify communities significantly different from the provincial average.

Methods: The outcome is LOS, adjusted for demographics and disease case-mix. Variation in LOS explained by community of residence is estimated using random intercept regression. Complex needs are defined using Elixhauser and Resource Intensity Weights. Small-area empirical Bayes estimates are calculated and mapped.

Results: Community of residence is associated with adjusted LOS, and its effect differ by complex needs. Of 77 communities, 17 had an adjusted LOS differing from the provincial average.

Conclusion: The community to which patients are discharged is associated with hospital LOS. Research is needed to understand why these communities are associated with longer or shorter adjusted LOS.