REDUCTION IN LENGTH OF HOSPITAL STAY FOR ACUTE CHILDHOOD ASTHMA ASSOCIATED WITH THE INTRODUCTION OF CASEMIX FUNDING

Objective: To examine changes to hospital admission rates, length of s tay (LOS), bed use, and unplanned readmission rates for children with acute exacerbations of asthma following the change of the Victorian he alth care system to casemix funding. Setting: Large university-affilia ted children's hospital in Melbourne, Victoria. Design: Prospective co llection of data from July 1989 to June 1996 for all children admitted with acute asthma(n=11 939). Results: The number of admissions for ac ute asthma showed a rising trend before the introduction of casemix fu nding in July 1993, and subsequently fell. There was a significant fal l in mean LOS (64.5 to 39 hours; -40%; P=0.001), and hence in bed-hour s occupied for asthma (115 370 to 61 116, -47%; P=0.001). There were n o increases in unplanned readmission rates for asthma within the next seven or 14 days. Conclusion: LOS and bed use for acute asthma at our hospital have been significantly reduced since the introduction of cas emix funding, although this study does not prove a causal relationship . There was no increase in readmission rates, and thus no suggestion o f any adverse effects as a result of reducing LOS. The 47% reduction i n bed-hours should lead to large reductions in cost to the hospital.