Abstract
BackgroundThe Japanese government has worked to reduce the length of hospital stay by introducing a per-diem hospital payment system that financially incentivizes the timely discharge of patients. However, there are concerns that excessively reducing length of stay may reduce healthcare quality, such as increasing readmission rates. The objective of this study was to investigate the temporal changes in length of stay and readmission rates as quality indicators in Japanese acute care hospitals.MethodsWe used an administrative claims database under the Diagnosis Procedure Combination Per-Diem Payment System for Japanese hospitals. Using this database, we selected hospitals that provided data continuously from July 2010 to March 2014 to enable analyses of temporal changes in length of stay and readmission rates. We selected stage I (T1N0M0) gastric, colon, and lung cancer surgical patients who had been discharged alive from the index hospitalization. The outcome measures were length of stay during the index hospitalization and unplanned emergency readmissions within 30 days after discharge.ResultsFrom among 804 hospitals, we analyzed 42,585, 15,467, and 40,156 surgical patients for gastric, colon, and lung cancer, respectively. Length of stay was reduced by approximately 0.5 days per year. In contrast, readmission rates were generally stable at approximately 2% or had decreased slightly over the 4-year period.ConclusionsIn early-stage gastric, colon, and lung cancer surgical patients in Japan, reductions in length of stay did not result in increased readmission rates.
Highlights
Due to rising healthcare costs, population aging, and shifting patient preferences, there is a need to increase the quality, efficiency, and value of health care
The objective of this study was to investigate the temporal changes in length of stay and readmission rates as quality indicators in Japanese acute care hospitals
In early-stage gastric, colon, and lung cancer surgical patients in Japan, reductions in length of stay did not result in increased readmission rates
Summary
Due to rising healthcare costs, population aging, and shifting patient preferences, there is a need to increase the quality, efficiency, and value of health care. The introduction of the Diagnosis Procedure Combination Per-Diem Payment System (DPC/ PDPS) for acute care hospitals in 2003 is likely to be a major cause for this reduction Under this system, hospital reimbursements from insurers for individual patients are reduced as LOS increases. The Japanese Ministry of Health, Labour and Welfare (MHLW) calculates the average LOS duration and cost for each DPC group (comprising patients with similar diagnoses and procedures) every two years, and specifies higher daily reimbursements in the early stages of hospitalization, moderate daily reimbursements for average LOS durations, and lower daily reimbursements for hospitalizations that exceed average LOS durations In this way, the payment system disincentivizes the protracted hospitalization of patients. The objective of this study was to investigate the temporal changes in length of stay and readmission rates as quality indicators in Japanese acute care hospitals.
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