Instability on Hospital Discharge and the Risk of Adverse Outcomes in Patients With Pneumonia

Abstract

OVER THE past 15 years, hospital length of stay has fallen dramatically. Studies assessing the impact of the prospective payment system on hospital care of Medicare beneficiaries in the 1980s indicated that this shortening length of stay was accompanied by a 43% relative increase in patients being sent home clinically unstable with unresolved medical issues.^1,2 This was worrisome because Medicare beneficiaries who were discharged unstable had a 60% greater odds of death.² This has been called the "quicker and sicker" phenomenon. The widespread diffusion of managed care throughout the 1990s has resulted in even more dramatic declines in the length of stay for many common conditions, including pneumonia.³ With patients needing to be sicker than ever to justify admission and the duration of hospital stays becoming even shorter, many providers, patients, and policy makers have expressed concern that patients are being sent home quicker and sicker than ever.^4-8