The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia
Abstract
:1. Introduction
2. Methods
2.1. Ethics Approval
2.2. Study Design and Participants
2.3. Data Sources and Variables Collected
2.4. Outcomes
2.5. Statistical Analysis
3. Results
3.1. Details of Study Cohort
3.2. Frequency of Prolonged Hospitalization and Details of Bed Utilisation
3.3. Factors Associated with Prolonged Hospitalization
3.4. Factors Associated with in-Hospital Mortality
3.5. Factors Associated with Hospital Discharge to Home
4. Discussion
4.1. Key Findings
4.2. Comparison with Previous Studies
4.3. Study Strengths and Limitations
4.4. Implications for Clinicians and Policy-Makers
4.5. Areas for Future Research
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variable | Overall | Period | |
---|---|---|---|
14 Nov. 2016–13 Nov. 2017 | 14 Nov. 2017–14 Nov. 2018 | ||
Number of cases (n) | 1,696,112 | 834,045 | 862,067 |
Female (n, %) | 877,020 (51.7) | 431,543 (51.7) | 445,477 (51.7) |
Age groups, years. (n, %) | |||
20–24 | 61,465 (3.6) | 30,666 (3.7) | 30,799 (3.6) |
25–29 | 65,547 (3.9) | 32,465 (3.9) | 33,082 (3.8) |
30–34 | 72,766 (4.3) | 35,991 (4.3) | 36,775 (4.3) |
35–39 | 75,571 (4.5) | 37,261 (4.5) | 38,310 (4.4) |
40–44 | 82,135 (4.8) | 41,519 (5.0) | 40,616 (4.7) |
45–49 | 95,566 (5.6) | 47,104 (5.7) | 48,462 (5.6) |
50–54 | 103,747 (6.1) | 51,793 (6.2) | 51,954 (6.0) |
55–59 | 121,095 (7.1) | 59,470 (7.1) | 61,625 (7.2) |
60–64 | 137,130 (8.1) | 67,467 (8.1) | 69,663 (8.1) |
65–69 | 163,254 (9.6) | 81,217 (9.7) | 82,037 (9.5) |
70–74 | 170,359 (10.0) | 81,641 (9.8) | 88,718 (10.3) |
75–79 | 168,124 (9.9) | 82,130 (9.9) | 85,994 (10.0) |
80–84 | 158,335 (9.3) | 77,411 (9.3) | 80,924 (9.4) |
≥85 | 221,018 (13.0) | 107,910 (12.9) | 113,108 (13.1) |
Indigenous population (n, %) | 13,888 (0.8) | 6604 (0.8) | 7284 (0.8) |
Marital Status (n, %) | |||
Never married | 325,672 (19.2) | 160,081 (19.2) | 165,591 (19.2) |
Widowed | 244,190 (14.4) | 120,811 (14.5) | 123,379 (14.3) |
Married or defacto | 955,280 (56.3) | 470,118 (56.4) | 485,162 (56.3) |
Divorced or separated | 143,222 (8.4) | 69,762 (8.4) | 73,460 (8.5) |
Other | 27,748 (1.6) | 13,273 (1.6) | 14,475 (1.7) |
DRG type | |||
Medical | 1,044,369 (61.6) | 508,577 (61.0) | 535,792 (62.2) |
Surgical | 571,449 (33.7) | 285,911 (34.3) | 285,538 (33.1) |
Other | 80,294 (4.7) | 39,557 (4.7) | 40,737 (4.7) |
Emergency admission (n, %) | 839,360 (49.5) | 405,571 (48.6) | 433,789 (50.3) |
Admission source (n, %) | |||
Home | 1,442,065 (85.0) | 710,111 (85.1) | 731,954 (84.9) |
Aged care residential facility | 11,302 (0.7) | 5234 (0.6) | 6068 (0.7) |
From another hospital | 195,230 (11.5) | 95,892 (11.5) | 99,338 (11.5) |
Other | 47,515 (2.8) | 22,808 (2.7) | 24,707 (2.9) |
ICU stay (n, %) | 79,115 (4.7) | 39,187 (4.7) | 39,928 (4.6) |
Admitted on weekend (n, %) | 573,292 (33.8) | 282,965 (33.9) | 290,327 (33.7) |
Season of admission (n, %) | |||
Spring (Sep-Nov) | 406,209 (24.0) | 204,835 (24.6) | 201,374 (23.4) |
Summer (Dec-Feb) | 415,172 (24.5) | 203,530 (24.4) | 211,642 (24.6) |
Autumn (Mar-May) | 433,328 (25.6) | 209,706 (25.1) | 223,622 (25.9) |
Winter (Jun-Aug) | 441,403 (26.0) | 215,974 (25.9) | 225,429 (26.2) |
Prior admissions in 12 months | |||
0 | 711,166 (41.9) | 411,233 (49.2) | 300,379 (34.8) |
1 | 374,576 (22.1) | 186,092 (22.3) | 188,760 (21.9) |
≥2 | 610,370 (36.0) | 238,009 (28.5) | 372,928 (43.3) |
Risk category based on admission unit | |||
1 | 659,004 (38.9) | 324,467 (38.8) | 334,991 (38.9) |
2 | 503,703 (29.7) | 245,034 (29.3) | 259,133 (30.1) |
3 | 387,474 (22.8) | 192,039 (23.0) | 195,701 (22.7) |
4 | 145,931 (8.6) | 73,794 (8.8) | 72,242 (8.4) |
In-hospital mortality (n, %) | 35,287 (2.1) | 17,535 (2.1) | 17,752 (2.1) |
Length of stay (days), (n, %) | |||
1–6 | 1284,508 (75.7) | 629,370 (75.5) | 655,138 (76.0) |
7–13 | 248,154 (14.6) | 122,166 (14.7) | 125,988 (14.6) |
14–20 | 83,037 (4.9) | 41,317 (5.0) | 41,720 (4.8) |
21–27 | 35,457 (2.1) | 17,696 (2.1) | 17,761 (2.1) |
≥28 | 44,956 (2.7) | 23,496 (2.8) | 21,460 (2.5) |
Days of Stay | Hospital Type | Number (%) Admissions * | Number (%) Bed Days |
---|---|---|---|
All length of stay | Overall | 1,696,112 (100) | 9,450,306 (100.0) |
Private | 608,815 (35.9) | 327,285 (34.6) | |
Regional | 207,938 (12.3) | 1,148,083 (12.1) | |
Secondary | 382,490 (22.6) | 1,984,477 (21.0) | |
Tertiary | 378,075 (22.3) | 1,962,871 (20.8) | |
Other | 118,794 (7.0) | 1,082,050 (11.4) | |
LOS1–6 days | Overall | 1,284,508 (75.7) | 2,988,383 (31.6) |
Private | 450,324 (74.0) | 1,047,298 (32.0) | |
Regional | 160,939 (77.4) | 386,284 (33.6) | |
Secondary | 302,906 (79.2) | 690,189 (34.8) | |
Tertiary | 294,359 (77.9) | 678,895 (34.6) | |
Other | 75,980 (64.0) | 185,717 (17.2) | |
LOS 7–13 days | Overall | 248,154 (14.6) | 2,285,159 (24.2) |
Private | 102,152 (16.8) | 945,255 (28.9) | |
Regional | 27,535 (13.2) | 251,200 (21.9) | |
Secondary | 48,214 (12.6) | 441,094 (22.2) | |
Tertiary | 51,832 (13.7) | 475,350 (24.2) | |
Other | 18,421 (15.5) | 172,260 (15.9) | |
LOS 14–20 days | Overall | 83,037 (4.9) | 1,354,911 (14.3) |
Private | 32,485 (5.3) | 524,364 (16.0) | |
Regional | 9446 (4.5) | 155,169 (13.5) | |
Secondary | 15,066 (3.9) | 247,272 (12.5) | |
Tertiary | 16,477 (4.4) | 270,422 (13.8) | |
Other | 9563 (8.1) | 157,684 (14.6) | |
LOS 21–27 days | Overall | 35,457 (2.1) | 831,620 (8.8) |
Private | 11,866 (1.9) | 2,77,342 (8.5) | |
Regional | 4251 (2.0) | 99,921 (8.7) | |
Secondary | 6710 (1.8) | 157,566 (7.9) | |
Tertiary | 7121 (1.9) | 167,133 (8.5) | |
Other | 5509 (4.6) | 129,658 (12.0) | |
LOS ≥ 28 days | Overall | 44,956 (2.7) | 1,990,233 (21.1) |
Private | 11,988 (2.0) | 478,566 (14.6) | |
Regional | 5767 (2.8) | 255,509 (22.3) | |
Secondary | 9594 (2.5) | 448,356 (22.6) | |
Tertiary | 8286 (2.2) | 371,071 (18.9) | |
Other | 9321 (7.8) | 436,731 (40.4) |
Variable | Longer LOS (Odds Ratio (OR), 95% CI) | Mortality (Hazard Ratio (HR) 95% CI) |
---|---|---|
Age groups, years | ||
20–24 | 0.74 (0.71–0.78) | 0.22 (0.18–0.29) |
25–29 | 0.85 (0.81–0.88) | 0.26 (0.21–0.32) |
30–34 | 0.97 (0.93–1.01) | 0.32 (0.27–0.38) |
35–39 | 1.01 (0.97–1.05) | 0.40 (0.35–0.46) |
40–44 | 0.97 (0.94–1.01) | 0.56 (0.50–0.63) |
45–49 | 0.95 (0.92–0.99) | 0.70 (0.64–0.77) |
50–54 | 0.96 (0.93–0.99) | 0.80 (0.74–0.87) |
55–59 | 0.95 (0.92–0.98) | 0.91 (0.85–0.97) |
60–64 | 1.0 [reference] | 1.0 [reference] |
65–69 | 1.03 (1.00–1.06) | 1.08 (1.02–1.14) |
70–74 | 1.16 (1.13–1.19) | 1.18 (1.12–1.24) |
75–79 | 1.47 (1.43–1.51) | 1.32 (1.25–1.39) |
80–84 | 1.80 (1.75–1.85) | 1.62 (1.54–1.71) |
≥85 | 2.32 (2.26–2.38) | 2.50 (2.38–2.62) |
Female gender | 1.09 (1.08–1.11) | 0.90 (0.88–0.92) |
Indigenous population | ||
Yes | 0.89 (0.83–0.95) | 1.05 (0.90–1.21) |
No | 1.0 [reference] | 1.0 [reference] |
Undefined | 1.13 (1.07–1.19) | 1.34 (1.22–1.47) |
Charlson co–morbidity Index | ||
0 | 1.0 [reference] | 1.0 [reference] |
1–2 | 1.44 (1.42–1.46) | 2.74 (2.63–2.85) |
3–4 | 2.04 (2.00–2.09) | 4.27 (4.09–4.46) |
5–6 | 2.15 (2.07–2.23) | 6.15 (5.81–6.50) |
>6 | 0.95 (0.93–0.98) | 10.68 (10.24–11.13) |
Marital Status | ||
Never married | 1.59 (1.56–1.61) | 0.89 (0.86–0.93) |
Widowed | 1.26 (1.23–1.28) | 0.95 (0.92–0.97) |
Married or defacto | 1.0 [reference] | 1.0 [reference] |
Divorced or separated | 1.37 (1.34–1.40) | 0.86 (0.83–0.90) |
Other | 1.29 (1.24–1.35) | 1.42 (1.32–1.52) |
Current smoker | 1.26 (1.24–1.28) | 0.87 (0.83–0.91) |
DRG type | ||
Medical | 1.0 [reference] | 1.0 [reference] |
Surgical | 0.60 (0.59–0.61) | 0.28 (0.26–0.29) |
Other | 0.79 (0.76–0.82) | 1.09 (1.04–1.14) |
Emergency (unscheduled) admission | 0.64 (0.63–0.65) | 1.61 (1.56–1.65) |
Admission source | ||
Home | 1.0 [reference] | 1.0 [reference] |
Aged care residential facility | 0.97 (0.90–1.04) | 2.49 (2.33–2.67) |
From another hospital | 4.12 (4.06–4.18) | 0.90 (0.87–0.93) |
Other | 4.24 (4.14–4.34) | 1.80 (1.73–1.87) |
ICU stay | 3.38 (3.31–3.45) | 3.17 (3.06–3.28) |
Admitted on weekend | 1.07 (1.05–1.08) | 0.94 (0.91–0.96) |
Season of admission | ||
Spring (Sep–Nov) | 1.0 [reference] | 1.0 [reference] |
Summer (Dec–Feb) | 1.17 (1.15–1.19) | 0.96 (0.93–0.99) |
Autumn (Mar–May) | 1.15 (1.13–1.17) | 0.98 (0.95–1.01) |
Winter (Jun-Aug) | 1.14 (1.13–1.16) | 0.98 (0.95–1.01) |
Prior admissions (in 12 months) | ||
0 | 1.0 [reference] | 1.0 [reference] |
1 | 1.22 (1.19–1.24) | 0.85 (0.81–0.88) |
≥2 | 1.32 (1.30–1.35) | 0.98 (0.95–1.01) |
Risk category based on admission unit | ||
1 | 1.0 [reference] | 1.0 [reference] |
2 | 1.86 (1.83–1.89) | 0.91 (0.87–0.94) |
3 | 2.42 (2.38–2.47) | 1.38 (1.34–1.43) |
4 | 8.39 (8.22–8.56) | 2.59 (2.50–2.69) |
Died in hospital | 0.90 (0.87–0.93) | - |
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
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Ofori-Asenso, R.; Liew, D.; Mårtensson, J.; Jones, D. The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia. J. Clin. Med. 2020, 9, 3055. https://doi.org/10.3390/jcm9093055
Ofori-Asenso R, Liew D, Mårtensson J, Jones D. The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia. Journal of Clinical Medicine. 2020; 9(9):3055. https://doi.org/10.3390/jcm9093055
Chicago/Turabian StyleOfori-Asenso, Richard, Danny Liew, Johan Mårtensson, and Daryl Jones. 2020. "The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia" Journal of Clinical Medicine 9, no. 9: 3055. https://doi.org/10.3390/jcm9093055