SHM Converge Scientific Abstract ePoster Gallery-Heavy Stuff: Discharge Density vs Length-of-Stay to Assess Performance

Pdf Summary

This study examined whether <strong>discharge density (DD)</strong> could serve as a better measure of individual hospitalist performance than <strong>length of stay (LOS)</strong>. The authors noted that LOS is a problematic quality metric because it is credited to the discharging attending, who may not have cared for the patient for most of the hospitalization. They proposed DD—the proportion of discharge visits to total visits during weeks when a hospitalist served as primary attending—as a potentially better indicator of discharge skill.

The investigators calculated <strong>LOS, adjusted LOS (using observed:expected ratios), and DD</strong> for <strong>31 hospitalists</strong> at a large academic medical center. Weekend encounters were excluded to avoid bias against hospitalists working more weekends, since weekend discharges were less common at their institution.

The results showed <strong>no statistically significant correlation between DD and LOS</strong>. Specifically, Pearson correlation between DD and LOS was <strong>r = -0.04 (p = 0.85)</strong>, and between DD and inlier LOS was <strong>r = -0.03 (p = 0.88)</strong>. DD also did not significantly correlate with <strong>adjusted LOS</strong> or <strong>readmission rate</strong>.

The authors concluded that DD and LOS appear to measure <strong>different aspects of practice</strong>, rather than overlapping ones. Because DD did not correlate with LOS or readmission rate, it may reflect a distinct dimension of hospitalist performance. However, further study is needed to determine whether DD aligns with other important quality measures.

The study suggests that hospital groups should be cautious about relying solely on LOS for performance evaluation and should consider additional metrics, including DD, in future dashboards, reviews, and incentive systems.

Asset Subtitle

Andrew S. Dunn

Meta Tag

Author List Andrew S. Dunn, Lizette Perez, Vinh-Tung P. Nguyen

Category Research

Concept Length of Stay

Concept Discharge Density

Concept Quality Metric

Concept Hospitalist

Concept Discharge Visit

Distinguished Non-Finalist

Presenter Organization Mount Sinai Health System

Presenting Author Andrew S. Dunn

Track Quality Improvement

Keywords

discharge density

length of stay

hospitalist performance

adjusted LOS

observed expected ratio

readmission rate

quality metrics

discharge skill

primary attending

hospital performance evaluation

Length of Stay

Discharge Density

Quality Metric

Hospitalist

Discharge Visit