Skip Navigation U.S. Department of Health and Human Services www.hhs.gov
Agency for Healthcare Research Quality www.ahrq.gov
Archive print banner

Outcomes/Effectiveness Research

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to www.ahrq.gov for current information.

Shorter hospital length of stay not associated with worse outcomes for patients without DNR orders

Although the amount of time that patients spent in the hospital declined dramatically between 1991 and 1997, this decline did not seem to result in worse outcomes for patients after discharge, according to research funded by the Agency for Healthcare Research and Quality (AHRQ grant HS09969).

The researchers, led by David Baker, M.D., M.P.H., of Feinberg School of Medicine, Northwestern University, examined trends in the risk of death during the 30 days after discharge for 83,895 Medicare patients hospitalized between 1991 and 1997. They analyzed data for patients at all 30 non-Federal hospitals in greater metropolitan Cleveland discharged alive with a principal diagnosis of acute myocardial infarction, congestive heart failure, gastrointestinal hemorrhage, chronic obstructive pulmonary disease, pneumonia, or stroke.

Overall, the researchers found no evidence that shorter length of stay was associated with higher rates of death or readmission after discharge. However, trends varied depending upon whether a DNR order was written. For patients who did not have a DNR order written, the risk of death during the 30 days after discharge generally remained stable over the study period. However, post-discharge mortality increased between 1991 and 1997 among patients with pneumonia, acute myocardial infarction, or stroke who had a DNR order written on the first or second hospital day.

The researchers believe the findings provide some reassurance that it is possible to reduce length of stay without jeopardizing patients' health. However, the findings for patients with early DNR orders raise concern. The increasing post-discharge mortality rate could reflect positive changes in end-of-life care, such as more widespread use of hospice, or this could indicate a decline in the quality of care for patients who are terminally ill. The researchers caution that additional studies are needed to examine whether in-hospital quality of care for patients with DNR orders has declined.

Details are in "Trends in post-discharge mortality and readmissions: Has length of stay declined too far?" by Dr. Baker, Doug Einstadter, M.D., M.P.H., Scott S. Husak, B.S., and Randall D. Cebul, M.D., in the March 8, 2004, issue of Archives of Internal Medicine 164, pp. 538-544.

Return to Contents
Proceed to Next Article

The information on this page is archived and provided for reference purposes only.

 

AHRQ Advancing Excellence in Health Care