ArticleHealth services research2006
Variation in hospital length of stay: do physicians adapt their length of stay decisions to what is usual in the hospital where they work?
Article in Health services research, 2006. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
28 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Physicians' and Hospital Administrators' Perspectives of Diagnosis-Related Groups (DRGs) in High-Income Countries: A Systematic Review.TheScientificWorldJournal · 2026Pooled it
- Reducing unnecessary hospital days to improve quality of care through physician accountability: a cluster randomised trial.BMC health services research · 2013Trial
- Does more generous health insurance reimbursement lead to moral hazard? Evidence from large-scale administrative data in China.The European journal of health economics : HEPAC : health economics in prevention and care · 2026Article
- The relationship between preoperative anemia and length of hospital stay among patients undergoing orthopedic surgery at a teaching hospital in Ethiopia: a retrospective cohort study.Perioperative medicine (London, England) · 2024Article
- Surgery for phaeochromocytomas and paragangliomas: Current practice in the United Kingdom.Annals of the Royal College of Surgeons of England · 2024Article
- Reduction of hospital length of stay through the implementation of SAFER patient flow bundle and Red2Green days tool: a pre-post study.BMJ open quality · 2024Article
- Practice variation in induction of labor: A critical document analysis on the contribution of regional protocols.PloS one · 2024Article
- Audit and feedback to reduce unwarranted clinical variation at scale: a realist study of implementation strategy mechanisms.Implementation science : IS · 2023Article
- Trauma-Related Clinical Practice Variation in Dutch Emergency Departments.Healthcare (Basel, Switzerland) · 2023Article
- The digitization process and the evolution of Clinical Risk Management concept: The role of Clinical Engineering in the operational management of biomedical technologies.Frontiers in public health · 2023Article
- One-Year Clinical Outcomes of Minimal-Invasive Dorsal Percutaneous Fixation of Thoracolumbar Spine Fractures.Medicina (Kaunas, Lithuania) · 2022Article
- Understanding variations and influencing factors on length of stay for T2DM patients based on a multilevel model.PloS one · 2021Article
- Single Incision Laparoscopic Surgery: Feasibility of the Direct Fascial Puncture Technique Without Working Trocars.Cureus · 2020Article
- Understanding unwarranted variation in clinical practice: a focus on network effects, reflective medicine and learning health systems.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2020Article
- Association of daily copayments with use of hospital care among medicare advantage enrollees.BMC health services research · 2019Article
- Regional Practice Patterns and Racial/Ethnic Differences in Intensity of End-of-Life Care.Health services research · 2018Article
- Meeting patient expectations: patient expectations and recovery after hip or knee surgery.Musculoskeletal surgery · 2018Article
- Has variation in length of stay in acute hospitals decreased? Analysing trends in the variation in LOS between and within Dutch hospitals.BMC health services research · 2015Article
- Variation in referrals to secondary obstetrician-led care among primary midwifery care practices in the Netherlands: a nationwide cohort study.BMC pregnancy and childbirth · 2015Observational
- Validity of the Postoperative Morbidity Survey after abdominal aortic aneurysm repair-a prospective observational study.Perioperative medicine (London, England) · 2015Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo test the hypothesis that physicians who work in different hospitals adapt their length of stay decisions to what is usual in the hospital under consideration. DATA SOURCES: Secondary data were used, originating from the Statewide Planning and Research Cooperative System (SPARCS). SPARCS is a major management tool for assisting hospitals, agencies, and health care organizations with decision making in relation to financial planning and monitoring of inpatient and ambulatory surgery services and costs in New York state. STUDY
designData on length of stay for surgical interventions and medical conditions (a total of seven diagnosis-related groups [DRGs]) were studied, to find out whether there is more variation between than within hospitals. Data (1999, 2000, and 2001) from all hospitals in New York state were used. The study examined physicians practicing in one hospital and physicians practicing in more than one hospital, to determine whether average length of stay differs according to the hospital of practice. Multilevel models were used to determine variation between and within hospitals. A t-test was used to test whether length of stay for patients of each multihospital physician differed from the average length of stay in each of the two hospitals. PRINCIPAL
findingsThere is significantly (p<.05) more variation between than within hospitals in most of the study populations. Physicians working in two hospitals had patient lengths of stay comparable with the usual practice in the hospital where the procedure was performed. The proportion of physicians working in one hospital did not have a consistent effect for all DRGs on the variation within hospitals.
conclusionPhysicians adapt to their colleagues or to the managerial demands of the particular hospital in which they work. The hospital and broader work environment should be taken into account when developing effective interventions to reduce variation in medical practice.
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