Length of hospital stay for elderly people is substantially higher in the NHS compared with Kaiser Permanente and US Medicare programmes - 24/08/11

Doi : 10.1016/j.ehbc.2004.03.016

David P Sklar, MD : Commentary Author
Chair, Department of Emergency Medicine, University of New Mexico School of Medicine, MSC10 5560, Albuquerque, USA

Abstract

Question

Does utilization of hospital beds by people aged over 65 years differ in the NHS in England, Kaiser Permanente in California and Medicare in California and the USA?

Study Design

Retrospective cohort study.

Main results

For all 11 causes of hospital admissions, standardised length of hospital stay for people aged >65 years was highest in the NHS (3.5 times as long as Kaiser, twice as long as Medicare California, and nearly 50% higher than Medicare in the United States). Standardised hospital admission rates for 11 leading causes of hospital admissions in people aged >65 years are generally highest for Medicare recipients in the United States and California, followed by the NHS in England and then Kaiser Permanente in California (see Table 1). However, there are important limitations to the reliability of these findings (see notes).

Authors’ conclusions

For 11 leading causes of acute hospital admissions in people aged >65 years, the NHS has generally lower hospital admission rates and longer hospital stays compared with Medicare recipients in the United States and California, and Kaiser Permanente in California.

Table 1 Number of hospital admissions (per 100,000 population) and length of stay (days) in people aged >65 years, standardised for English population data.
Clinical Diagnosis	NHS		Kaiser		Medicare California		Medicare United States
	Admissions	Stay	Admissions	Stay	Admissions	Stay	Admissions	Stay
Stroke	823	27.08	788	4.26	1155	5.84	1183	6.53
Chronic obstructive pulmonary disease	699	9.87	558	3.79	1067	5.35	1256	5.37
Bronchitis or asthma	531	11.73	141	3.09	225	4.22	310	4.41
Coronary bypass	144	13.27	97	9.60	296	8.63	321	9.98
Acute myocardial infarction	550	9.39	893	4.35	675	5.14	923	5.46
Heart failure/shock	556	12.42	1118	3.70	1893	5.28	2272	5.37
Angina pectoris	783	5.88	152	2.21	176	2.58	203	2.56
Hip replacement	342	12.60	256	4.54	602	5.41	644	5.46
Knee replacement	344	11.32	367	4.17	479	4.54	557	4.40
Hip fracture	315	26.88	388	4.89	489	5.97	535	6.47
Kidney or urinary infection	396	15.19	526	3.80	726	5.11	708	5.32

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Keywords : Patient admission, Bed occupancy, Length of stay, Elderly, NHS, Medicare, HMO, Cohort study

Plan

Commentary

Study parameters

Abstracted from: Ham C, York N, Sutch S, Shaw R. Hospital bed utilisation in the NHS, Kaiser Permanente, and the US Medicare programme: analysis of routine data. BMJ 2003; 327: 1257–1260.