The average length of hospital stay for patients has ‘plummeted’ over the last thirty years, from 10 days in 1983 to 5 days in 2013. However, the proportion of patients discharged to a nursing facility has quadrupled over this same period. So, from the point of view of the patient, the stay away from home has not changed as much as it might be inferred from an uncritical analysis of inpatient stays. So, how have home-to-home times changed? This was assessed by Barnett et al. on the basis of Medicare administration claims for 82 million hospitalisations over the years 2004 to 2011 inclusive.
Yes, the mean length of hospital stay declined (from 6.3 to 5.7 days), but the mean length of stay in post-acute care facilities increased from 4.8 to 6 days. Total home-to-home time increased from 11.1 to 11.7 days. This is not necessarily a bad thing, but it must be taken into account in assessing costs and benefits of care. The risk of iatrogenic harm and costs are lower in nursing facilities than hospitals. However, the article cited here does not consider the possibility that these risks and costs are not lower for the group of people in nursing facilities who would otherwise be cared for in hospital.
— Richard Lilford, CLAHRC WM Director
- Centers for Medicare and Medicaid Services. CMS program statistics: 2013 Medicare Utilization Section. 2017.
- Tian W (AHRQ). An All-Payer View of Hospital Discharge to Postacute Care, 2013. Rockville, MD: Agency for Healthcare Research and Quality; 2016.
- Barnett ML, Grabowski DC, Mehrotra A. Home-to-Home Time – Measuring What Matters to Patients and Payers. N Engl J Med. 2017; 377: 4-6.