Prolonging Influence on Length of Stay
According to Bickel et al., “Two out of five elderly patients in general hospitals suffer from a cognitive disturbance” (1). 18.4% were afflicted with dementia. Correctly, the authors note that this was the proportion of those patients who were in the hospital at the same time. In our opinion, the 18.4% point prevalence rate corresponds to a period prevalence rate of almost 10% of patients aged 65 and older for whom dementia has been recorded as a secondary diagnosis in routine data (2).
In studies on the frequency of illnesses in hospitals, the influence of length of stay should be considered. The likelihood that a treatment case is included in a survey on a reference date increases with the corresponding patient’s length of stay. For instance, a long-term patient cared for all year round is included on each reference date; for a one-day case, the probability is only 1/365. Illnesses for which hospitalization represents a risk of acquisition therefore have a higher point prevalence rate than period prevalence rate. The same applies to illnesses that prolong the stay. As both effects can be combined, deviations of a factor of 2 are possible.
Dementia as an influencing factor that increases length of stay has been discussed (3). This can also be assumed for dementia-related illnesses as well as for older age. We therefore recommend that you recalculate the results so that a comparison can be made with period prevalence rates, for example using a direct standardization using the number of days of the length of stay. We would not be surprised if the conclusion were: one of every ten elderly patients in general hospital care is afflicted with dementia. This would be a validation for using routine data when including vulnerable populations into multi-institutional quality management initiatives.
Prof. Dr. med. Jürgen Stausberg
Arzt für Medzinisches und Ärztliches Qualitätsmanagement
Essen, Germany, email@example.com
Dipl.-Kf. Thomas Jungen
Caritasverband für die Diözese Trier e. V., Germany
Dr. med. Christoph Scheu, MBA
Klinikum St. Elisabeth Straubing GmbH, Germany
Conflict of interest statement
The authors declare that no conflict of interest exists.
|1.||Bickel H, Hendlmeier I, Heßler JB, et al.: The prevalence of dementia and cognitive impairment in hospitals—results from the General Hospital Study (GHoSt). Dtsch Arztebl Int 2018; 115: 733–40 VOLLTEXT|
|2.||Stausberg J: Welche projektspezifischen Indikatoren sind sinnvoll. Qualitätsindikatoren für Kirchliche Krankenhäuser (QKK). 10. Januar 2012. www.qkk-online.de/fileadmin/user_upload/dokumente/empfehlung_20120110.pdf [Last accessed on 13 November 2018].|
|3.||Motzek T, Junge M, Gesine Marquardt G: [Impact of dementia on length of stay and costs in acute care hospitals]. Z Gerontol Geriatr 2017; 50: 59–66. CrossRef MEDLINE|