Increased Risk of Mortality among Patients Cared for by Physicians with Short Length-of-Stay Tendencies

Since the introduction of the prospective payment system in 1983, U.S. hospitals have been financially incentivized to reduce inpatient length of stay, and average length of stay has shortened dramatically. The purpose of this study was to determine whether short length of stay is associated with worse patient outcomes. We used a quasi-experimental design to compare the outcomes of admissions assigned to physicians with short versus long length-of-stay tendencies. We used each physician's mean length of stay to define their length of stay tendency. We then compared the outcomes of admissions assigned to physicians with short versus long length-of-stay tendencies in propensity score-matched and adjusted analyses using mixed-effects and conditional logistic regression models. The study included all admissions for 10 common diagnoses among patients admitted to the medical teaching service of an urban academic hospital from 7/1/2002 through 6/30/2008. The primary outcome was 30-day mortality. We examined 12,341 admissions among 79 physicians. After propensity score matching, admission groups were similar with respect to all demographic and clinical characteristics. Admissions of patients receiving care from short length-of-stay physicians were associated with significantly increased risk of 30-day mortality in adjusted (OR 1.43, 95 % CI: 1.11-1.85), propensity score-matched (OR 1.33, 95 % CI: 1.08-1.63), and matched and adjusted analyses (OR 1.36, 95 % CI: 0.98-1.90). Policies that incentivize short length of stay may lead to worse patient outcomes. The financial benefits of shortening inpatient length of stay should be weighed against the potential harm to patients.