Patients with epilepsy had a shorter length of stay when they were admitted to hospitals that were private/nonprofit or nonteaching.
SAN ANTONIO—Private/non-profit or nonteaching status, location in the Midwest, South, or West regions, and small or medium bed size are among the hospital characteristics that are associated with a shorter length of stay for patients with epilepsy, researchers reported at the 64th Annual Meeting of the American Epilepsy Society.
Tzena M. Smith, ScD, of Tulane University in New Orleans, and colleagues investigated the relationship between hospital characteristics and length of stay in 264,151 weighted hospital discharges with a primary diagnosis of epilepsy.
The researchers used an inverse Gaussian regression model to look for associations between length of stay and hospitals’ control/ownership, geographic region, teaching status, location, and bed size. This model incorporated such factors as patients’ age and gender, admission sources, payer information, median household income, admission type, number of medical diagnoses and procedures, and severity measures.
Among the sampled patients, the mean hospital length of stay was 3.64 days. Seventy percent of patients were admitted through the emergency room, and 23.8% of admissions were in the collapsed category of “routine/birth/other.”
Private/nonprofit hospitals were associated with a shorter length of stay than public hospitals (odds ratio [OR], .924) and nonteaching hospitals were associated with a shorter length of stay than teaching hospitals (OR, .943). Rural hospitals were associated with a shorter length of stay than urban hospitals (OR, .856). Hospitals in the Midwest, South, and West were associated with a shorter length of stay than hospitals in the Northeast (ORs, .836, .879, and .885, respectively). In addition, small and medium bed-sized hospitals were associated with a shorter length of stay than large bed-sized hospitals (ORs, .917 and .944, respectively).
The investigators offered a few possible explanations for these findings. “Patients with epilepsy are primarily utilizing large bed-sized, teaching hospitals, which tend to be located in urban areas and report a longer length of stay,” they wrote. “To receive treatment for complex and sometimes severe medical conditions, patients with epilepsy may be seeking hospitals with greater scale and service capacity, [including] video monitoring or surgical evaluation.”
Large bed-sized, teaching hospitals might be able to reduce the length of stay of patients with epilepsy, they added. The researchers recommended that clinicians at these hospitals collaborate with neurologists affiliated with nonteaching, small bed-sized, or medium bed-sized hospitals to implement such preventative practices as increased routine monitoring of antiepileptic drug levels.
—Jack Baney