Relation between length of hospital stay and costs of care for patients with community-acquired pneumonia

doi:10.1016/S0002-9343(00)00500-3

The American Journal of Medicine

Volume 109, Issue 5, 1 October 2000, Pages 378-385

https://doi.org/10.1016/S0002-9343(00)00500-3 Get rights and content

Abstract

PURPOSE: Patients with pneumonia often remain hospitalized after becoming clinically stable, without demonstrated benefits on outcome. The purposes of this study were to assess the relation between length of hospital stay and daily medical care costs and to estimate the potential cost savings associated with a reduced length of stay for patients with pneumonia.

SUBJECTS AND METHODS: As part of a prospective study of adults hospitalized with community-acquired pneumonia at a community hospital and two university teaching hospitals, daily medical care costs were estimated by multiplying individual charges by department-specific cost-to-charge ratios obtained from each hospital’s Medicare cost reports.

RESULTS: The median total cost of hospitalization for all 982 inpatients was $5,942, with a median daily cost of $836, including $491 (59%) for room and $345 (41%) for non-room costs. Average daily non-room costs were 282% greater on the first hospital day, 59% greater on the second day, and 19% greater on the third day than the average daily cost throughout the hospitalization (all P <0.05), and were 14% to 72% lower on the last 3 days of hospitalization. Average daily room costs remained relatively constant throughout the hospital stay, with the exception of the day of discharge. A projected mean savings of $680 was associated with a 1-day reduction in length of stay.

Conclusions: Despite institutional differences in total costs, patterns of daily resource use throughout hospitalization were similar at all institutions. A 1-day reduction in length of stay might yield substantial cost-savings.

Section snippets

Study sites and patients

The Pneumonia Patient Outcomes Research Team (PORT) cohort study was conducted from October 1991 through March 1994 at four hospital sites: hospital A, a 427-bed community teaching hospital, and hospital B, a 942-bed university teaching hospital, both in Pittsburgh, Pennsylvania; hospital C, an 899-bed university teaching hospital in Boston, Massachusetts; and hospital D, a 637-bed university teaching hospital in Halifax, Nova Scotia, Canada (8). The sample for this study was limited to

Results

Of the 982 PORT inpatients enrolled at hospitals A, B, and C, 863 (88%) met the inclusion criteria for this study; 119 inpatients were excluded for one or more of the following reasons: death before hospital discharge (n = 51), outlier for cost (n = 48), outlier for length of stay (n = 22), unverified cost data (n = 16), transfer to another acute care hospital (n = 8), and missing detailed billing data (n = 5).

Discussion

This prospective, multicenter study of the relation between length of stay and daily costs demonstrated a common pattern of resource use throughout the hospital stay, with a substantial variation in the magnitude of average daily and total costs among three hospitals. The pattern was characterized by the highest level of use within the first 3 days of hospitalization and the lowest level of use on the day of discharge and the 2 days preceding discharge. Hospital room costs were relatively

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^☆: This research was conducted as part of the Pneumonia Patient Outcomes Research Team (PORT) Project funded by the Agency for Health Care Policy and Research (grant number R01 HS06468). Dr. Fine was also supported as a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar.

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Clinical studyRelation between length of hospital stay and costs of care for patients with community-acquired pneumonia☆

Abstract

Section snippets

Study sites and patients

Results

Discussion

Chest

Am J Med

Births and deathsUnited States, 1996

Vital Stat Rep

The cost of treating patients with community-acquired pneumonia

Sem Respir Crit Care Med

Time to clinical stability in patients hospitalized with community-acquired pneumonia

JAMA

Clinical study
Relation between length of hospital stay and costs of care for patients with community-acquired pneumonia☆