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The Association Between Hospital Occupancy and Mortality Among Medicare Patients. | LitMetric

AI Article Synopsis

  • Hospital crowding poses a significant challenge for U.S. healthcare, yet its impact on patient mortality remains under-studied.
  • The study assessed data from 1998 to 2012 for Medicare patients aged 65+ with specific health conditions, examining the relationship between hospital occupancy and mortality rates.
  • Findings revealed that higher discharge day occupancy was linked to lower inpatient mortality but an increase in 30-day out-of-hospital mortality, suggesting that crowded hospitals may shift patient deaths to the outpatient setting.

Article Abstract

Background: Hospital crowding is a major challenge facing US health care systems, but few studies have evaluated the association between inpatient occupancy and patient mortality. The objective of this study was to determine how increasing hospital occupancy is associated with the likelihood of inpatient and 30-day out-of-hospital mortality using a novel measure of inpatient occupancy.

Methods: The researchers conducted a retrospective, observational study using secondary data from the California Office of Statewide Health Planning and Development, including nonfederal, acute care facilities from 1998 to 2012. Using measures of relative hospital occupancy, the researchers ran logistic regressions to assess the relationship between increasing hospital occupancy and inpatient mortality and 30-day out-of-hospital mortality among Medicare patients age 65 years and older with myocardial infarction, heart failure, or pneumonia.

Results: Higher admission day occupancy (odds ratio [OR] = 0.96, 95% confidence interval [CI]: 0.94-0.99) and higher discharge day occupancy (OR = 0.62, 95% CI: 0.60-0.64) were associated with decreased inpatient mortality. Thirty-day out-of-hospital mortality increased with higher discharge day occupancy (OR=1.28, 95% CI: 1.24-1.32) but was unrelated to admission day occupancy.

Conclusion: This study found a counterintuitive relationship between admission and discharge day occupancy and inpatient mortality. Higher discharge day occupancy appears to displace deaths into the outpatient setting. Understanding why higher inpatient occupancy is associated with lower overall mortality merits investigation to inform best practices for inpatient care in busy hospitals.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483708PMC
http://dx.doi.org/10.1016/j.jcjq.2020.05.003DOI Listing

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