Interpreting risk-adjusted length of stay patterns for VA hospitals

OBJECTIVES. The Veterans Health System must become more competitive with th e private sector in terms of efficiency of care. Studies have shown signifi cantly longer lengths-of-stay (LOS) in facilities operated by the Departmen t of Veterans Affairs (VA) compared with private sector facilities. Most co mparisons, however, have not controlled well for casemix differences or hav e involved small numbers of patients. The aims of this study were: (1) controlling for casemix, to accurately mea sure the degree by which average length of stay in Veterans Affairs facilit ies exceeds that of private sector hospitals and (2) to demonstrate a metho dology with which individual VA facilities can identify clinical and demogr aphic subgroups of patients associated with the higher length-of-stay avera ges. METHODS. Subjects of the study were Veterans Health System patients hospita lized during 1991-1993 and veteran respondents to the 1991 National Hospita l Discharge Survey. Hospitals' mean length of stay adjusted for patients' d iagnosis related groups, severity, demographics, and travel distances were measured. RESULTS. Veterans Affairs medical centers' average risk-adjusted length of stay was 36% higher (8.9 days compared with 6.5 days) than that of the priv ate sector. For individual hospitals, relative length-of-stay efficiency ty pically varied by condition. Among 14 hospitals in the VA's midwest region, none were high risk-adjusted length-of-stay outliers in all conditions stu died, and four were high outliers for some conditions and low outliers for others. CONCLUSIONS. Controlling for differences in patient demographic and clinica l factors, Veterans Affairs medical centers consumed significantly more day s of care than private sector hospitals. Veterans Affairs medical centers w ill be able to improve efficiency by identifying specific subgroups of pati ents whose clinical treatment should be examined.