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.