Determinants of Hospital Stay in a Highly Complex University Hospital
DOI:
https://doi.org/10.17533/udea.rfnsp.e351811Keywords:
health resource management, hospital management, diagnosis-related groups, hospitalization, statistical modelsAbstract
Objective: To establish and quantify the determinants of hospital stay in a high complexity university hospital in Medellin between 2013 and 2018, assess their importance, and model the expected length of stay.
Methodology: Retrospective analytical observational study of aggregate data. While following the method step by step, seven models were used, where mean hospital stay was the dependent variable and the respective independent variables were complexity, timeliness of diagnostic procedures, availability of supplies, cases of prolonged stay and financial capacity. The best model was selected using the Akaike and Bayesian information criterion, along with measures of both overall significance and individual significance of the coefficients. Statistical tests of model validity were performed and standardized coefficients were calculated.
Results: The mean values of the most relevant variables and their standard deviation (SD) were: mean hospital stay, 8.09 days (SD = 0.40); complexity by resource consumption, 1.28 units (SD = 0.07); diagnostic procedures, 90.74 thousand studies (SD = 10.05); cases of extremely prolonged stay, 4.36% (SD = 0.70), and complexity by casuistry, 1 (SD = 0.03). Overall significance: F = 55.2, p < 0.001. Significance of coefficients: complexity by resource consumption, p < 0.01; diagnostic procedures and cases of extremely prolonged stay, p < 0.001; complexity by casuistry, p < 0.05. Standardized coefficients: complexity by resource consumption, 0.35; diagnostic procedures, 0.35; cases of extremely prolonged stay, 0.26; and complexity by casuistry, 0.24. Adjusted R2 0.82.
Conclusion: In order of importance, the determinants of hospital stay are complexity by resource consumption, diagnostic procedures, extremely prolonged stay, complexity by casuistry, available inventory and gross profit.
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. Serrou D, Abouabdellah A, Mharzi H. Proposed an approach for measuring the performance of hospital logistics systems by integrating quality, safety and environment. Int J Sci Eng Technol. [internet]. 2015 [citado 2022 ago. 20]; 4(1):24-7. Disponible en: https://www.indianjournals.com/ijor.aspx?target=ijor:ijset1&volume=4&issue=1&article=006
. López Cano LM, Valencia Vargas A. Caracterización de los egresos hospitalarios con tumores malignos según la información de los Grupos Relacionados con el Diagnóstico. Fac Nac Salud Pública. 2017;35(3):382-9. doi: https://doi.org/10.17533/udea.rfnsp.v35n3a08
. Rodríguez Bolaños R de los Á, Reynales Shigematsu LM, Jiménez Ruiz JA, et al. Costos directos de atención médica en pacientes con diabetes mellitus tipo 2 en México: análisis de microcosteo. Rev Panam Salud Pública. [internet]. 2010 [citado 2022 sep. 22]; 28:412-20. Disponible en: https://www.scielosp.org/article/rpsp/2010.v28n6/412-420/
. Calderón C, Dennis R. Costos económicos de neumonía adquirida en comunidad, meningitis y bacteriemia por Streptococcus pneumoniae en una población adulta que requirió hospitalización en Bogotá, Colombia. Biomédica. 2014;34(1):92-101. doi: https://doi.org/10.7705/biomedica.v34i1.1553
. Amegbor PM, Plumb KB, Rosenberg MW. Determinants of overnight stay in health centres and length of admission: A study of canadian seniors. Can J Aging. 2020;39(4):533-44. doi: https://doi.org/10.1017/S0714980819000771
. Mathew PJ, Jehan F, Kulvatunyou N, et al. The burden of excess length of stay in trauma patients. Am J Surg. 2018;216(5):881-5. doi: https://doi.org/10.1016/j.amjsurg.2018.07.044
. Patel S, Alshami A, Douedi S, et al. Improving hospital length of stay: Results of a retrospective cohort study. Healthcare. 2021;9(6):762. doi: https://doi.org/10.3390/healthcare9060762
. Casalino E, Perozziello A, Choquet C, et al. Evaluation of hospital length of stay and revenues as a function of admission mode, clinical pathways including observation unit stay and hospitalization characteristics. Health Serv Manage Res. 2019;32(1):16-25. doi: https://doi.org/10.1177/0951484818767606
. Toro Rendón LG, Franco Arenas CP, Palacios-Barahona U. Costs associated with early vascular and biliary complications in liver-transplanted patients in a hospital in Antioquia, Colombia 2019: A case series. Value Health Reg Issues. 2020;23:131-6. doi: https://doi.org/10.1016/j.vhri.2020.06.004
. Benavides Zúñiga A, Castillo Franco G, et al. Factores que prolongan la estancia hospitalaria en el Hospital N acional pnp Luis N. Sáenz. Rev Med Humana-Univ Ricardo Palma [internet]. 2006 [citado 2022 sep. 22]; 6(2):3-12. Disponible en: https://docplayer.es/35432968-Factores-que-prolongan-la-estancia-hospitalaria-en-el-hospital-n-acional-pnp-luis-n-saenz.html
. Sarkies M, Long JC, Pomare C, et al. Avoiding unnecessary hospitalisation for patients with chronic conditions: A systematic review of implementation determinants for hospital avoidance programmes. Implement Sci. 2020;15(1):91. doi: https://doi.org/10.1186/s13012-020-01049-0
. Otto R, Blaschke S, Schirrmeister W, et al. Length of stay as quality indicator in emergency departments: Analysis of determinants in the German Emergency Department Data Registry (aktin registry). Intern Emerg Med. 2022;17(4):1199-209. doi: https://doi.org/10.1007/s11739-021-02919-1
. Pérez Moreno J, Mata Navazo S de la, López-Herce Arteta E, et al. Influencia del estado nutricional en la evolución clínica del niño hospitalizado. An Pediatría. 2019;91(5):328-35. doi: https://doi.org/10.1016/j.anpedi.2019.01.014
. Puozaa C. The determinants of hospital length of stay in Nigeria. Rochester, NY [internet]. 2016 [citado 2022 sep. 21]. Disponible en: https://papers.ssrn.com/abstract = 3002308
. Mora SL, Barreto CA, García LR. Procesos médico-administrativos en hospitalarios y prolongación de la estancia. Hospital de San José, Bogotá D. C. Colombia. Rev Repert Med Cir. 2015;24(4):284-93. doi: https://doi.org/10.31260/RepertMedCir.v24.n4.2015.603
. Marfil-Garza BA, Belaunzarán-Zamudio PF, Gulias-Herrero A, et al. Risk factors associated with prolonged hospital length-of-stay: 18-year retrospective study of hospitalizations in a tertiary healthcare center in Mexico. PloS One. 2018;13(11):e0207203. doi: https://doi.org/10.1371/journal.pone.0207203
. Martínez JB. El Ebitda. Cont4bl3. [internet]. 2012 [citado 2022 sep. 22]; (41):15-7. Disponible en: https://dialnet.unirioja.es/servlet/articulo?codigo=3859966
. Águila A, Muñoz MA, Sepúlveda V. Experiencia en el desarrollo e implementación de la metodología de grupos relacionados por diagnóstico en un hospital universitario chileno. Evaluación a diez años de funcionamiento. Rev Méd. Chile. 2019;147(12):1518-26. doi: http://dx.doi.org/10.4067/S0034-98872019001201518
. Caro-Miranda J, Sepúlveda N, Bórquez C, et al. Análisis con grd: el egreso hospitalario indiferenciado de la maternidad no representa la complejidad de las pacientes con alto riesgo obstétrico. Rev Chil Obstet Ginecol. 2020;85(2):132-8. doi: http://dx.doi.org/10.4067/S0717-75262020000200132
. Núñez E, Steyerberg EW, Núñez J. Estrategias para la elaboración de modelos estadísticos de regresión. Rev Esp Cardiol. 2011;64(6):501-7. doi: https://doi.org/10.1016/j.recesp.2011.01.019
. Rivera Santana R, Rojas González PD, Herrera Corrado C. Análisis de gestión clínica asociada a la producción hospitalaria, Hospital de Urgencia Asistencia Pública Dr. Alejandro del Río [internet]; 2015 [citado 2022 sep. 21]. Disponible en: https://1library.co/document/yj8jeemq-analisis-gestion-clinica-asociada-produccion-hospitalaria.html
. Jiménez R, López L, et al. Difference between observed and predicted length of stay as an indicator of inpatient care inefficiency. Int J Qual Health Care. 1999;11(5):375-84. doi: https://doi.org/10.1093/intqhc/11.5.375
. Suasnabar Dávila JA. Factores asociados a prolongación de estancia hospitalaria en pacientes postoperados en el servicio de cirugia de la Clinica Good Hope, en el año 2016 [tesis de grado]. [Lima, Perú]: Universidad Ricardo Palma [internet]. 2018 [citado 2022 oct. 3]. Disponible en: https://repositorio.urp.edu.pe/handle/20.500.14138/1257
. Torres García DC. Auditoría financiera y de gestión. Evaluación estados financieros y presupuesto Corporación Hospital Infantil Concejo de Medellín. Vigencia 2020. Contraloría General de Medellín [internet]. 2021 [citado 2022 oct. 3]. Disponible en: https://www.cgm.gov.co/cgm/Paginaweb/IP/Informes%20de%20Auditora%20PGA%202021/Informe%20Definitivo%20%20Auditoria%20Financiera%20y%20de%20Gesti%C3%B3n%20%20CHICM.pdf
. Bonilla Sandoval P. Evaluación componente control financiero 2017 Hospital General de Medellín Luz Castro de Gutiérrez e.s.e. Contraloría General de Medellín [internet]; 2018 [citado 2022 oct. 3]. Disponible en: https://www.hgm.gov.co/loader.php?lServicio=Tools2&lTipo=descargas&lFuncion=descargar&idFile=263
. Fundación Santa Fe de Bogotá-Hospital Universitario. Memoria económica para el año gravable 2020 [internet]; 2021 [citado 2022 sep. 21] Disponible en: https://www.fsfb.org.co/wps/wcm/connect/fsfb/33df2e56-687d-4ce6-ac0f-f8109ca4019d/MEMORIA+ECONOMICA+2020.pdf?MOD=AJPERES&CVID=nyTTcHv
. Correa Barrios N. La experiencia de los grupos relacionados de diagnóstico (grd’s) en el Centro Médico Imbanaco de Cali. Centro Médico Imbanaco [internet]. [citado 2022 mar. 21] Disponible en: https://es.scribd.com/document/469682378/B17-Nathalie-Correa#
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