Casemix. A cross-national, casemix analysis of hospital length of stay for selected pathologies

Background: The factors which contribute to length of stay variations for hospital discharges is the focus of an expanding body of international research. Methods: The study reported here is intended to facilitate an advancement of this research as the analysis described was undertaken on a unique multinational database within which over 3.3 million cases from 12 countries have been compiled in a standardised manner. Differences in length of stay both within and between countries were assessed for over 119,400 discharges within selected high-volume pathologies classified according to three alternative measures of hospital casemix. Results: The results show that irrespective of the casemix measure applied, substantial unexplained variation in hospital length of stay persists both within and between countries for the pathologies reviewed. Conclusions: These results suggest that, in addition to standardising for casemix, future research on length of stay variation should focus on additional potentially influential factors, including health system characteristics, medical practice variation and patient behaviour and expectations.