Length of stay and hospital costs among patients admitted to hospital by family physicians

Chuck K. Wen; Catharine Chambers; Dianne Fang; Garey Mazowita; Stephen W. Hwang

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Table 1

Patient characteristics by group

CHARACTERISTIC	OVERALL (n = 613)	GROUP A (n = 424)	GROUP B (n = 189)	PVALUE
Mean (SD) age, y	73.4 (16.8)	73.8 (16.9)	72.5 (16.7)	.385
Sex, n (%)				.389
• Female	337 (55.0)	238 (56.1)	99 (52.4)
• Male	276 (45.0)	186 (43.9)	90 (47.6)
Neighbourhood-level income,^* n (%)				.199
• Lowest quintile	259 (46.4)	171 (45.4)	88 (48.6)
• 2nd quintile	92 (16.5)	63 (16.7)	29 (16.0)
• 3rd quintile	85 (15.2)	51 (13.5)	34 (18.8)
• 4th quintile	71 (12.7)	53 (14.1)	18 (9.9)
• Highest quintile	51 (9.1)	39 (10.3)	12 (6.6)
Resident of nursing home, n (%)	98 (16.0)	73 (17.2)	25 (13.2)	.213
Had a family physician in the community, n (%)	600 (97.9)	424 (100.0)	176 (93.1)	< .001
Died during hospitalization, n (%)	58 (9.5)	39 (9.2)	19 (10.1)	.738
Left against medical advice, n (%)	23 (3.8)	12 (2.8)	11 (5.8)	.072
Median (IQR) ELOS, d	6.5 (5.1 to 9.7)	6.5 (5.0 to 9.7)	6.8 (5.2 to 9.8)	.495
RIW, median (IQR)	1.1 (0.8 to 2.0)	1.1 (0.8 to 1.9)	1.2 (0.8 to 2.2)	.279

ELOS—expected length of stay, IQR—interquartile range, RIW—resource intensity weight.
↵* Neighbourhood-level income data missing for 55 admissions.

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Table 2

MRD for hospitalization classifications

MRD CLASSIFICATION (ICD-10-CA CODE)	OVERALL N = 613), N (%)	GROUP A (N = 424), N (%)	GROUP B (N = 189), N (%)	PVALUE^*
Chronic obstructive pulmonary disease (J44)	60 (9.8)	44 (10.4)	16 (8.5)	.556
Pneumonia (J18)	42 (6.9)	28 (6.6)	14 (7.4)	.731
Heart failure (I50)	28 (4.6)	20 (4.7)	8 (4.2)	1.00
Palliative care (Z51.5)	23 (3.8)	17 (4.0)	6 (3.2)	.818
Urinary tract infection (N39.0)	21 (3.4)	13 (3.1)	8 (4.2)	.476
Cellulitis (L03)	20 (3.3)	11 (2.6)	9 (4.8)	.216
Dementia (F01–F03)	16 (2.6)	9 (2.1)	7 (3.7)	.278
Delirium, not induced by alcohol or other psychoactive substances (F05)	16 (2.6)	14 (3.3)	2 (1.1)	.168
Stroke, including intracerebral hemorrhage and cerebral infarction (I62–I64)	12 (2.0)	8 (1.9)	4 (2.1)	1.00
Tendency to fall, not elsewhere classified (R29)	12 (2.0)	9 (2.1)	3 (1.6)	.763
Volume depletion and other disorders of fluid, electrolyte, and acid-base balance (E86–E87)	11 (1.8)	9 (2.1)	2 (1.1)	.517
Dorsalgia (back pain) (M54)	11 (1.8)	5 (1.2)	6 (3.2)	.103
Care involving use of rehabilitation procedures (Z50)	11 (1.8)	4 (0.9)	7 (3.7)	.041
Abdominal and pelvic pain (R10)	10 (1.6)	8 (1.9)	2 (1.1)	.731
Septicemia due to bacterial infection (A40–A41)	9 (1.5)	7 (1.7)	2 (1.1)	.728
Diabetes mellitus (type 1 or type 2) (E10–E11)	9 (1.5)	8 (1.9)	1 (0.5)	.287
Fracture of shoulder and upper arm (S42)	8 (1.3)	4 (0.9)	4 (2.1)	.259
HIV disease (B24)	7 (1.1)	7 (1.7)	0 (0.0)	.106
Secondary malignant neoplasm of respiratory and digestive organs (C78)	7 (1.1)	6 (1.4)	1 (0.5)	.682
Renal failure, acute or chronic (N17–N18)	7 (1.1)	7 (1.7)	0 (0.0)	.106
Enterocolitis due to Clostridium difficile (A04.7)	6 (1.0)	1 (0.2)	5 (2.6)	.012
Pneumonitis due to solids and liquids (J69)	6 (1.0)	5 (1.2)	1 (0.5)	.672
Noninfectious enteritis and colitis (K52)	6 (1.0)	5 (1.2)	1 (0.5)	.672
Pain in joint (M25.5)	6 (1.0)	3 (0.7)	3 (1.6)	.379
Malaise and fatigue (R53)	6 (1.0)	3 (0.7)	3 (1.6)	.379
Fracture of lumbar spine and pelvis (S32)	6 (1.0)	3 (0.7)	3 (1.6)	.379
Mental and behavioural disorders due to use of alcohol (F10)	5 (0.8)	1 (0.2)	4 (2.1)	.033
Diverticular disease of intestine (K57)	5 (0.8)	4 (0.9)	1 (0.5)	1.000
Constipation (K59.0)	5 (0.8)	3 (0.7)	2 (1.1)	.646
Cachexia (R64)	5 (0.8)	3 (0.7)	2 (1.1)	.646
Fracture of ribs, sternum, and thoracic spine (S22)	5 (0.8)	4 (0.9)	1 (0.5)	1.000
Other conditions	212 (34.6)	151 (35.6)	61 (32.3)	.462

ICD-10-CA—International Statistical Classification of Diseases and Related Health Problems, 10th revision, Canadian edition; MRD—most responsible diagnosis.
↵* Fisher exact test (2-sided).

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Table 3

Median values and IQRs for outcomes by group

OUTCOME	GROUP A (N = 424), MEDIAN (IQR)	GROUP B (N = 189), MEDIAN (IQR)	PVALUE
LOS, d	8.0 (4.0 to 13.0)	8.0 (4.0 to 15.0)	.687
LOS - ELOS, d	0.6 (−2.7 to 4.7)	0.2 (−3.2 to 5.5)	.657
LOS:ELOS	1.1 (0.6 to 1.7)	1.0 (0.5 to 1.8)	.826
Total hospital costs,^* $	6498 (4035 to 11 313)	6798 (4040 to 12 713)	.673
Total hospital costs per RIW unit,^* $	5952 (3985 to 8167)	5428 (3955 to 8356)	.406

ELOS—expected length of stay, IQR—interquartile range, LOS—length of stay, LOS - ELOS—difference between LOS and ELOS, LOS:ELOS—acute LOS to ELOS ratio, RIW—resource intensity weight.
↵* Total hospital costs missing for 66 admissions.