Case study assignment question 3


Robert L. Houchens and Nancy Schoeps

This case study investigates the relative importance of several factors in predicting the length of time young patients with asthma stay in the hospital. With the present atmosphere of cutting health care costs it is important to look at providing adequate care while at the same time reducing costs and not keeping children in the hospital longer than necessary. By looking at a sample of patients with pediatric asthma, concomitant factors to the main reason for being admitted to the hospital may shed light on different lengths of stay.


In today's healthcare environment, health insurance companies are increasingly pressuring hospitals to provide high quality health services at the lowest possible cost. The vast majority of all healthcare costs are for hospitalization. During the past decade, inpatient costs of patients in hospitals have been reduced in two primary ways. First, the less severe cases are now treated in the doctor's office or in hospital emergency rooms rather than being admitted to the hospital. Second, for cases admitted to the hospital, the lengths of hospital stays have been considerably shortened.

It is believed that some insurers have been more successful than others at minimizing hospital lengths of stay

(LOS). To test this, a sample of hospital medical records was drawn for each of several illnesses from metropolitan hospitals operating in one state. The data for this case study consists of information abstracted from the medical records of asthma patients between the ages of 2 and 18 years old.


The sample of medical records was drawn in two stages. At the first stage, 29 metropolitan hospitals were sampled with probabilities proportional to an estimate of the number of asthma admissions it had during a single year. At the second stage, 393 asthma cases insured by Insurer A were randomly selected and 396 asthma cases insured by Insurer B were randomly selected from the 29 hospitals. Information was abstracted from each patient's medical record. Aside from the main variables of interest, insurer and LOS, the additional

information falls into four categories:

  1. Patient Severity Variables describe the severity of the patient's condition at admission to the hospital. Included in this category are comorbidities, additional conditions that may exacerbate the condition that is the major reason for admission. The LOS is expected to be longer for more severely ill patients and for

patients with comorbidities.

  1. Demographic Variables describe the patient's age, sex, and race. The effect of demographic factors on LOS for patients with pediatric asthma is not known.
  2. Hospital Variables describe the characteristics of the hospital in which the patient was treated. It is expected that LOS will be lower for hospitals with more services and with a higher staff-to-bed ratio. The effects of size of hospital, measured by the number of beds in the hospital (bedsize), and the categorization of that hospital as a teaching hospital or not (teachcat) have not been explored. In this case

study these variables are named bedsize and teachcat.

  1. Treatment Variables describe aspects of the patient's treatment during hospitalization. Treatment variables are not fully known until the hospital stay is complete. It is expected that LOS will be longer for patients who have treatment complications and process of care failures (the hospital fails to adhere to standards of care given the patient's condition). Finally, patients with more diagnostic tests probably are more severely ill. Consequently, LOS is expected to increase with the number of tests performed.


  • Are there differences in LOS between the insurers?
  • Investigate the factors associated with LOS to better understand their influence on hospital length of stay

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