Referring CVA patients from acute hospitals to long term care institutes: Determination of the most appropriate time using statistical modeling on hospital charges - An example from a medical center

A few statistical models were constructed to investigate the most appropriate time to refer hospitalized CVA patients from a medical center to long term care institutes. Based on the assumption that patients' physical conditions can be reflected in their hospital fees, the cumulative charges were examined by a two-piece regression. It is perhaps most efficient, from hospital management's point of view, to transfer patients at the time where the difference between the slopes of the regression lines before and after this point is maximized. Alternatively, one can also maximize the difference in average daily charges before and after such point, or when the cumulative charges reach, say, 75%, 80% or 90%. The studied sample consisted of 1357 CVA inpatients randomly drawn from a medical center in northern Taiwan. Their average length of stay (LOS) was 22.9 days, with a mean hospital fee of NT$76325. Results of the piecewise regression analysis show that most patients can be referred in 3 to 5 days. On the other hand, we also found that 75%-90% of the total fee was accumulated in the first 12-13 days. Should patients be transferred within the derived days, operating efficiency can increase by 12%-34%. Since only fees are used in the modeling process as the dependent variable, but physical conditions and outcomes of the patients have been largely ignored, results of this research can by no means be considered complete. Yet this still seems to be one of the pioneer projects investigating 'referral date', instead of the reasonably well studied 'length of stay'. Therefore, it is suggested that further research be carried out from a more medical point of view, so that the combined results will be more comprehensive.