Primary health care and hospital interactions: Effects for hospital length of stay

Abstract

Aims: Norwegian healthcare services are divided between primary and secondary care providers. A growing problem is that every third patient of 75 years of age or more experiences an extended stay in a somatic hospital while waiting to be sent to primary healthcare services. The interaction between these two levels of healthcare services is analysed to examine the effect on a patient's length of stay in hospital. Methods: Recent studies have asserted that research on length of stay in hospital should include influential factors such as system variation and system characteristics, in addition to standardizing for casemix. New organizational routines are identified in 50 Norwegian somatic hospitals. A multivariate linear regression is used in both a static and a dynamic model to explain variations in hospital length of stay and in additional length of stay (5% of stays are defined as outliers). Results: The study shows that newly specialized structures constructed to enhance the interaction between the two levels have had no effect. Length of stay is dependent on the capacity of the primary healthcare provider and on the share of elderly in the hospital catchment area, the type of patients, the procedure performed, and the characteristics of the hospital. Conclusion: Variation in length of stay between hospitals is primarily explained by the capacity of primary healthcare providers. However, some support is found in the dynamic model that introduces the proposition that a hospital-owned hotel would decrease the length of stay of patients in hospital.

Keywords

Hospital length of stay municipality organization primary care services

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References

Sosialdepartementet. St meld nr 9: Sykehusutbygging m.v. i et regionalisert helsevesen [Hospital planning in a regionalized health care system]. Oslo: Norges offentlige publikasjoner, 1974.

Helsetilsynet. Gamle i sykehus [Elderly in hospitals]. Oslo: Statens helsetilsyn, 2000.

Kaag MEC , Wijkel D. , DeJong D. Primary health care replacing hospital care — the effect on quality of care. Int J Qual Health Care 1996;8:367—73.

Kodner DL , Spreeuwenberg C. Integrated care: meaning, logic, applications, and implications — a discussion paper. Int J Integrated Care 2002 ;2:1—8.

Burns LR , Pauly MV

Integrated delivery networks: a detour on the road to integrated health care?

Health Affairs 2002;21:128—43.

Rønningen L. Samdata sykehus: tabeller: sammenligningsdata for somatisk fylkeshelsetjeneste 2000 [Samdata Hospitals: comparative statistics for somatic specialist care 2000]. Trondheim: SINTEF Unimed NIS SAMDATA, 2001.

Aileen C. , Rosen R.

Length of stay. How short should hospital care be?

Eur J Public Health, 2001:166—77.

Swartz M. , Iezzoni LI , Ash AS , Mackiernan YD Do severity measures explain differences in length of hospital stay? The case of hip fracture. Health Services Res 1996;31:365—85.

Wiley M. , Tomas R. , Casas M. A cross-national, casemix analysis of hospital length of stay for selected pathologies. Eur J Public Health 1999;9:86—92.

10.

Westert G. , Nieboer A. , Groenewegen P. Variation in duration of hospital stay between hospitals and between doctors within hospitals. Soc Sci Med 1993;37:833—9.

11.

Cavan DA , Hamilton P. , Everett J. , Kerr D. Reducing hospital inpatient length of stay for patients with diabetes. Diabetic Med 2001;18:162—4.

12.

Lilleeng S. Trimpunkt, kostnadsvekter og enhetspriser for HCFA versjon 3 og 8 [Outliers, cost-weights and index-prices for HCFA version 3 and 8]. Trondheim: Norsk institutt for sykehusforskning , 1992.

13.

Silber JH , Rosenbaum PR , Koiziol LF , Sutaria N. , M Rr , Even-Shoshan O. Conditional length of stay. Health Services Res 1999;34(1 (part II)).

14.

Magnussen J. DRG-systemet anvendelser og konsekvenser [The DRG-system. Use and consequences] . Trondheim: SINTEF Unimed, 1986.

15.

Thomas JW , Bates EW , Hofer T. , Perkins A. , Foltz-Murphy N. , Webb C. Interpreting risk-adjusted length of stay patterns for VA hospitals. Med Care 1998;36:1660—75.

16.

Heggestad T. Do hospital length of stay and staffing ratio affect elderly patients' risk of readmission? A nation-wide study of Norwegian hospitals. Health Services Res 2002;37:647—65.

17.

Lee AH , Yau KKW. Determining the effects of patient casemix on length of hospital stay: a proportional hazards frailty model approach . Methods Inf Med 2001; 40:288—92.

18.

Thorsvik D. Primærhelsetjenesten og sykehusforbruket [Primary care and hospital use]. Verdal: Gruppe for helsetjenesteforskning, SIFF, 1986.

19.

Gujarati DN Basic econometrics. 3rd ed. New York: McGraw-Hill, 1995.

20.

Baltagi BH Econometric analysis of panel data. 2nd ed. Chichester: Wiley, 2001.

21.

NOU. Pasienten først! Ledelse og organisering i sykehus [Patient focused care! Leadership and organization in hospitals]. (NOU 1997:2). Oslo: Statens forvaltningstjeneste Statens trykning, 1997.

22.

Biørn E. , Hagen TP , Iversen T. , Magnussen J. The effect of activity-based financing on hospital efficiency: a panel data analysis of DEA efficiency scores 1992—2000. Health Care Manage Sci 2003;6:271—83.

23.

Iversen T. , Kopperud GS The impact of accessibility on the use of specialist health care in Norway. Health Care Manage Sci 2003;6:249—61.