People admitted to hospital with physical disability have increased length of stay: implications for diagnosis related group re-imbursement in England
1 University of Kent, Centre for Health Services Studies, Canterbury, Kent, UK
2 Health and Social Care Information Centre, Leeds, UK
3 Imperial College, Statistical Advisory Service, London, UK
4 University of Aberdeen, Department of Medicine and Therapeutics, Aberdeen, UK
Address correspondence to: I. Carpenter. Tel: +44 (0)1227 827760 Fax: +44 (0)1227 827868. Email: g.i.carpenter{at}ukc.ac.uk
Objectives to assess whether measures of cognitive and physical function can explain differences in observed and healthcare resource group (HRG) predicted length of stay for patients presenting with six target conditions at admission.
Design prospective observational study.
Setting three East Kent district general hospitals.
Participants One thousand nine hundred and forty-two consecutive emergency admissions, from March to July2004, with ne or more of six presenting conditions (stroke, fracture neck of femur, myocardial infarction, acute respiratory infection, chronic obstructive airways disease and falls).
Main Outcome Measures length of stay by physical and cognitive function score adjusted for HRG allocated at discharge and other covariates. Physical function was defined using Activities of Daily Living Hierarchy Scale and cognitive function using the Cognitive Performance Scale.
Results median difference between observed and HRG predicted length of stay was 1.2 days (25th percentile estimate, 3.9; 75th percentile estimate, 10.1) for patients with high physical dependency. They stayed 40% longer (95% confidence interval 26-56%) than patients with lower physical dependency after excluding effects of HRG and other covariates. Results are not consistent for cognitive function scores, mainly because most patients had no cognitive impairment.
Conclusions these patients, presenting with conditions common in older patients, would have incurred estimated annual costs of £1.9 million in excess of their HRG tariff-based re-imbursement. Physical function, defined by the degree of dependency in activities of daily living, should be incorporated into HRGs to reduce the financial risk faced by acute hospital services under Payment by Results, the UK diagnosis related group re-imbursement system.
Keywords: case-mix, length of stay, disability, health care costs, diagnosis related groups, elderly
Received 24 January 2006;
Revision received 6 October 2006.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  N. D. Bakerly, C. Davies, M. Dyer, and P. Dhillon Cost analysis of an integrated care model in the management of acute exacerbations of chronic obstructive pulmonary disease Chronic Respiratory Disease, November 1, 2009; 6(4): 201 - 208. [Abstract] [PDF]
|
|
|
|
 |
|
 Y.-M. Chen, L.-K. Chen, J.-L. Lan, and D.-Y. Chen Geriatric syndromes in elderly patients with rheumatoid arthritis Rheumatology, October 1, 2009; 48(10): 1261 - 1264. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A.R.L. Medford, S. Agrawal, C.M. Free, and J.A. Bennett Retrospective analysis of Healthcare Resource Group coding allocation for local anaesthetic video-assisted 'medical' thoracoscopy in a UK tertiary respiratory centre QJM, May 1, 2009; 102(5): 329 - 333. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Espallargues, I. Philp, D.G. Seymour, S.E. Campbell, W. Primrose, S. Arino, E. Dunstan, G. Lamura, P. Lawson, E. Mestheneos, et al. Measuring case-mix and outcome for older people in acute hospital care across Europe: the development and potential of the ACMEplus instrument QJM, February 1, 2008; 101(2): 99 - 109. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Rozzini, T. Sabatini, A. Ranhoff, and M. Trabucchi Disability, clinical complexity, and diagnosis-related groups in old patients Age Ageing, July 1, 2007; 36(4): 472 - 473. [Full Text] [PDF]
|
|