INTER-HOSPITAL VARIABILITY IN TIME TO DISCHARGE TO REHABILITATION AMONG INSURED TRAUMA PATIENTS. The journal of trauma and acute care surgery Knowlton, L. M., Harris, A. H., Tennakoon, L., Hawn, M. T., Spain, D. A., Staudenmayer, K. L. 2018


BACKGROUND: Hospital costs are partly a function of length of stay (LOS), which can be impacted by the local availability of post-acute care (PAC) resources (inpatient rehabilitation and skilled nursing facilities), particularly for injured patients. We hypothesized that LOS for trauma patients destined for PAC would be variable based on insurance type and hospitals from which they are discharged.METHODS: We used the 2014-2015 National Inpatient Sample from the Healthcare Cost and Utilization Project (HCUP). We included all adult admissions with a primary diagnosis of trauma (ICD-9CM codes), who were insured and discharged to PAC. We then ranked hospitals based upon mean LOS and divided them into quartiles to determine differences. The primary outcome was inpatient LOS; secondary outcome was cost.RESULTS: 958,005 trauma patients met inclusion criteria. Mean LOS varied based upon insurance type (Medicaid vs. Private vs. Medicare: 12.7 days vs. 8.8 and 5.7: p<0.001). Shortest LOS hospitals had a marginal variation in LOS (Medicaid vs. Private vs. Medicare: 5.5 days vs. 4.8 vs. 4.2, p<0.001). Longest LOS hospitals had mean LOS that varied substantially (16.4 vs. 11.0 vs. 6.7 days, p<0.001). Multivariate regression controlling for patient and hospital characteristics revealed that Medicaid patients spent Medicaid patients spent an additional 0.4 days in shortest LOS hospitals and an additional 2.6 days in longest LOS hospitals (p<0.001). The average daily cost of inpatient care was $3,500 (SD $132). Even with conservative estimates, Medicaid patients at hospitals without easy access to rehabilitation incur significant additional inpatient costs over $10,000 in some hospitals.CONCLUSION: Prolonged LOS is likely a function of access to post-acute facilities, which is largely out of the hands of trauma centers. Efficiencies in care are magnified by access to post-acute beds, suggesting that increased availability of rehabilitation facilities, particularly for Medicaid patients, might help to reduce length of stay.LEVEL OF EVIDENCE: Epidemiologic, level III.

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