Shorter stays, but what about outcomes?

Managed care has reduced the time older patients with pneumonia spend in the hospital and has led to a corresponding drop in the costs and hospital death rates associated with the illness. But according to a study by researchers at Yale and other institutions, more patients are dying in the month after they leave the hospital, and many of the discharged hospital patients are being sent to nursing homes rather than home. Thomas P. Meehan, M.D., M.P.H., assistant clinical professor of medicine, was senior author of the study, which appeared in the Archives of Internal Medicine in December. The researchers found that the rate of mortality within 30 days after discharge increased from 6.9 percent to 9.3 percent during the six-year study of pneumonia patients 65 and older who were discharged from Connecticut hospitals. During that period, fall 1991 to fall 1997, the length of stay dropped from a mean of 11-12 days to 7-8 days. Said Meehan, “We can’t continue to decrease the length of stay and not have an eye as to the consequences.”