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http://dx.doi.org/10.5762/KAIS.2011.12.3.1234

A Study on analysis of severity-adjustment length of stay in hospital for community-acquired pneumonia  

Kim, Yoo-Mi (Dept. of Health Policy & Management, Sangji University)
Choi, Yun-Kyoung (Health Insurance Review & Assessment Service)
Kang, Sung-Hong (Dept. of Health Policy & Management, InJe University)
Kim, Won-Joong (Dept. of Health Policy & Management, InJe University)
Publication Information
Journal of the Korea Academia-Industrial cooperation Society / v.12, no.3, 2011 , pp. 1234-1243 More about this Journal
Abstract
Our study was carried out to develop the severity-adjustment model for length of stay in hospital for community-acquired pneumonia so that we analysed the factors on the variation in length of stay(LOS). The subjects were 5,353 community-acquired pneumonia inpatients of the Korean National Hospital Discharge In-depth Injury Survey data from 2004 through 2006. The data were analyzed using t-test and ANOVA and the severity-adjustment model was developed using data mining technique. There are differences according to gender, age, type of insurance, type of admission, but there is no difference of whether patients died in hospital. After yielding the standardized value of the difference between crude and expected length of stay, we analysed the variation of length of stay for community-acquired pneumonia. There was variation of LOS in regional differences and insurance type, though there was no variation according whether patients receive their care in their residences. The variation of length of stay controlling the case mix or severity of illness can be explained the factors of provider. This supply factors in LOS variations should be more studied for individual practice style or patient management practices and healthcare resources or environment. We expect that the severity-adjustment model using administrative databases should be more adapted in other diseases in practical.
Keywords
Community-Acquired Pneumonia; Length of stay; Severity-Adjustment; Data mining; Administrative Database;
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Times Cited By KSCI : 4  (Citation Analysis)
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1 Wennberg JE. "Dealing with medical practice variations: A proposal for action" Health Aff (Millwood)., vol. 3, no. 2, pp. 6-32, 1984.   DOI
2 de Jong JD, Westert GP, Lagoe R, Groenewegen PP. "Variation in hospital length of stay: Do physicians adapt their length of stay decisions to what is usual in the hospital where they work?" Health Serv Res., vol. 41, no. 2, pp. 374-394, 2006.   DOI
3 Meehan TP, Weingarten SR, Holmboe ES, Mathur D, Wang Y, Petrillo MK, Tu GS, Fine JM. "A statewide initiative to improve the care of hospitalized pneumonia patients: The connecticut pneumonia pathway project" Am J Med., vol. 111, no. 3, pp. 203-210, 2001.   DOI
4 Rhew, D.C., Riedinger, M.S., Sandhu, M., Bowers, C., Greengold, N. & Weingarten, S.R., "A prospective, multicenter study of a pneumonia practice guideline", Chest, vol. 114, no. 1, pp. 115-119, 1998.   DOI
5 Fine MJ, Hough LJ, Medsger AR, Li YH, Ricci EM, Singer DE, Marrie TJ, Coley CM, Walsh MB, Karpf M, Lahive KC, Kapoor WN. "The hospital admission decision for patients with community-acquired pneumonia. results from the pneumonia patient outcomes research team cohort study" Arch Intern Med., vol. 157, no. 1, pp. 36-44, 1997b.   DOI
6 임상진료지침 정보센터 , 임상진료지침 개발현황. Available: http://www.guideline.or.kr/index.php [2011, 7 Jan].
7 Moon S, Lee JS, Kim Y, You SJ, Choi YK, Suh SK, Kim YI. "Quality and affecting factor of care for patients hospitalized with pneumonia" Tuberc Respir Dis., vol. 66, no. 4, pp. 300-308, 2009.   DOI   ScienceOn
8 최종후, 서두성. "데이터마이닝 의사결정나무의 응용" 통계분석연구, 제4권, 제1호, pp. 61-83, 1999.
9 Restrepo, M.I., Mortensen, E.M., Pugh, J.A. & Anzueto, A. 2006, "COPD is associated with increased mortality in patients with community-acquired pneumonia", Eur Respir J., vol. 28, no. 2, pp. 346-351, 2006.   DOI
10 김유미, 강성홍, "입원의료의 타 지역 이용에 관한 연구", 한국산학기술학회논문지, 제10권, 제11호, pp. 3444-3450, 2009.   과학기술학회마을   DOI
11 Wright SP, Verouhis D, Gamble G, Swedberg K, Sharpe N, Doughty RN. "Factors influencing the length of hospital stay of patients with heart failure" Eur J Heart Fail., ,vol.5,no.2,pp.201-209, 2003.   DOI
12 Clarke A. "Why are we trying to reduce length of stay? evaluation of the costs and benefits of reducing time in hospital must start from the objectives that govern change" Qual Health Care., vol. 5, no. 3, pp. 172-179, 1996.   DOI
13 도영경 2007, "미국의 지역간 의료이용의 변이 연구: 비판적 검토와 함의", 보건행정학회지, 제17권, 제1호, pp. 94-124, 2007.   과학기술학회마을   DOI
14 Flood AB, Ewy W, Scott WR, Forrest WH,Jr, Brown BW,Jr. "The relationship between intensity and duration of medical services and outcomes for hospitalized patients" Med Care., vol. 17, no. 11, pp. 1088-1102, 1979.   DOI
15 Gornick M. "Trends and regional variations in hospital use under medicare" Health Care Financ Rev. vol. 3, no. 3, pp. 41-73, 1982.
16 Rosenthal GE, Sarrazin MV, Harper DL, Fuehrer SM. "Mortality and length of stay in a veterans affairs hospital and private sector hospitals serving a common market" J Gen Intern Med., vol. 18, no. 8, pp. 601-608, 2003.   DOI
17 McCormick D, Fine MJ, Coley CM, Marrie TJ, Lave JR, Obrosky DS, Kapoor WN, Singer DE. "Variation in length of hospital stay in patients with community-acquired pneumonia: Are shorter stays associated with worse medical outcomes?" Am J Med., vol. 107, no. 1, pp. 5-12, 1999.   DOI   ScienceOn
18 Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, Coley CM, Marrie TJ, Kapoor WN., "A prediction rule to identify low-risk patients with community-acquired pneumonia.", N Engl J Med., vol. 336, no. 4, pp.243-250, 1997.   DOI
19 Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, Lewis SA, Macfarlane JT., "Defining community acquired pneumonia severity on presentation to hospital: An international derivation and validation study.", Thorax., vol. 58, no. 5, pp. 377-382, 2003.   DOI
20 Robinson, J.M., Development of Severity-Adjustment Models for Hospital Efficiency Data: A White Paper Analysis, 2008. Available: http://www.leapfroggroup.org/media/file/Leapfrog_Resou rce_Utilization_Risk-Adjustment_Model_White_Paper.pd f [2011, Jan 7].
21 Jin, Y., Marrie, T.J., Carriere, K.C., Predy, G., Houston, C., Ness, K. & Johnson, D.H., "Variation in management of community-acquired pneumonia requiring admission to Alberta, Canada hospitals", Epidemiology and infection, vol. 130, no. 1, pp. 41-51, 2003.   DOI
22 Song, J.H. & Jung, K.S., "Treatment Guidelines for Community-acquired Pneumonia in Korea: An Evidence-based Approach to Appropriate Antimicrobial Therapy", J. Korean Med. Assoc., vol. 53, no. 1, pp.20-42, 2010.   DOI
23 강성홍, "퇴원환자의 재원일수 변이 분석: 2004-2006년 퇴원손상심층조사 결과 중심으로", 주간 건강과 질병, 제2권, 제51호, pp. 857-866. 12월, 2009.
24 윤영경, 김정연, 박윤선, 박대원, 손장욱, 엄중식, 천병철, 김은주, 김민자, "한국에서 2004년에 발생한 지역사회 폐렴의 역학 및 항생제 사용 행태", 대한내과학회지, 제75권, 제s2호, pp. 549-550, 2008.
25 Jasti, H., Mortensen, E.M., Obrosky, D.S., Kapoor, W.N. & Fine, M.J., "Causes and risk factors for rehospitalization of patients hospitalized with community-acquired pneumonia", Clin Infect Dis., vol. 46, no. 4, pp.550-556, 2008.   DOI
26 National Health Insurance Corporation, Health Insurance Review & Assessment Service. "2009 national health insurance statistical Yearbook" Seoul: National Health Insurance Corporation, Health Insurance Review & Assessment Service, Seoul; 2010.
27 McGregor MJ, Fitzgerald JM, Reid RJ, Levy AR, Schulzer M, Jung D, Groshaus HE, Cox MB. "Determinants of hospital length of stay among patients with pneumonia admitted to a large canadian hospital from 1991 to 2001" Can Respir J., vol. 12, no. 7, pp. 365-370, 2005.
28 Fine MJ, Pratt HM, Obrosky DS, Lave JR, McIntosh LJ, Singer DE, Coley CM, Kapoor WN. "Relation between length of hospital stay and costs of care for patients with community-acquired pneumonia" Am J Med. vol. 109, no. 5, pp.378-385, 2000.
29 McPherson K. "Length of stay and health outcome" Br Med J (Clin Res Ed)., vol. 288, no. 6434, pp. 1854-1855, 1984.   DOI
30 Chassin MR, Office Of Technology Assessment. "Health technology case study 24: Variations in hospital length: Of stay: Their relationship to health outcomes" OTAHCS-23 ed. Washington, DC: US Congress: Va., Ntis; 1983.
31 Menendez R, Cremades MJ, Martinez-Moragon E, Soler JJ, Reyes S, Perpina M. "Duration of length of stay in pneumonia: Influence of clinical factors and hospital type" Eur Respir J., vol. 22, no. 4, pp. 643-648, 2003.   DOI
32 Stahl JEM, Barza MM, DesJardin JM, Martin RR, Eckman MHM. "Predictors of length of hospital stay in community-acquired pneumonia" Infectious Diseases in Clinical Practice, vol. 11, no. 2, pp.46-51, 2002.   DOI
33 Fine MJ, Smith MA, Carson CA, Mutha SS, Sankey SS, Weissfeld LA, Kapoor WN. "Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysis" JAMA. vol. 275, no. 2, pp. 134-141, 1996.   DOI
34 Metlay JP, Schulz R, Li YH, Singer DE, Marrie TJ, Coley CM, Hough LJ, Obrosky DS, Kapoor WN, Fine MJ. "Influence of age on symptoms at presentation in patients with community-acquired pneumonia" Arch Intern Med., vol. 157, no. 13, pp. 1453-1459, 1997.   DOI
35 Korea National Statistical Office. "Annual report on the cause of death statistics 2009: Nationalwide" Daejeon: Korea National Statistical Office; 2010.
36 Jung KS. "Diagnosis of community-acquired pneumonia", J Korean Med Assoc., vol. 50, no. 10, pp. 877-885, 2007.   DOI
37 Halm EA, Teirstein AS. "Clinical practice. management of community-acquired pneumonia", N Engl J Med., vol 347. no. 25, pp. 2039-2045, 2002.   DOI
38 U.S. Department of Heatlh and Human Services, "National vital statistics report - deaths: Final data for 2007", Report No.: 58, May 2010.
39 Song JH, Jung KS, Kang MW, Kim DJ, Pai H, Suh GY, Shim TS, Ahn JH, Ahn CM, Woo JH, Lee NY, Lee DG, Lee MS, Lee SM, Lee YS, Lee H, Chung DR, A Joint committee for CAP Treatment Guideline. "Treatment guidelines for community-acquired pneumonia in korea: An evidence-based approach to appropriate antimicrobial therapy", Tuberc Respir Dis., vol. 67, no. 4, pp.281-302, 2009.   DOI