Length of stay variations between rural and urban patients with acute myeloid leukemia: a case-matched study
Sean J. Heinz A C and Sam Milliken BA Nepean Hospital, PO Box 63, Penrith, NSW 2751, Australia.
B St Vincents Hospital, 390 Victoria Street, Darlinghurst, NSW 2010, Australia. Email: smilliken@stvincents.com.au
C Corresponding author. Email: sean.heinz@hotmail.com
Australian Health Review 37(3) 397-401 https://doi.org/10.1071/AH13021
Submitted: 23 September 2012 Accepted: 10 March 2013 Published: 17 May 2013
Abstract
Background. Keeping patients in hospital longer than medically necessary is costly and occupies resources that could be better utilised. If patients from regional areas remain in hospital longer because of logistical issues such as transport and accommodation, then there is an argument for establishing or expanding appropriate medical services for rural areas. However, if the length of stay (LOS) for rural and urban patients is similar, it could be surmised that current logistic services appropriately meet demand.
Methods. This study reviews the cases of 40 patients with acute myeloid leukemia. This disease was selected as patients are generally required to travel to a metropolitan hospital for treatment, regardless of location. Twenty patients resided within the Sydney metropolitan area and 20 lived in rural New South Wales. Each of the 20 metropolitan patients were case-matched (1 : 1) with 20 rural patients with reference to sex, specific acute myeloid leukemia subtype (by World Health Organisation ICD-10 classification), and age.
Results. Following statistical non-parametric (t-test) analysis, rural and urban medians were found to be very similar with a high t-value and small mean (urban median = 29, rural median = 29.5, t-value = 0.722, m = –0.95, s.d. = 15.236, two-tailed P = 0.789, 95% CI = –7.89, 5.99). This demonstrates that there was no statistically significant difference between mean LOS for rural or urban patients after case-matching, a conclusion supported by qualitative analysis of the data.
Conclusion. Logistical issues are therefore unlikely to keep rural patients with AML in hospital beyond their immediate medical treatment.
What is known about this topic? A United States-based study found that LOS in hospital for rural patients with human immunodeficiency virus was one-third longer than for urban patients across each of the 6 years analysed (from 1998 to 2003). However it was noted that after adjusting for covariates such as age and sex, differences between LOS for rural and urban residents were not of statistical significance.
What does this paper add? This paper provides evidence that current services are utilised appropriately by demonstrating that rural and urban patients spend on average the same amount of time in hospital. Factors such as lack of transport or accommodation are therefore unlikely to keep rural patients in hospital beyond their immediate medical requirements. This paper adds to the limited research base within the Australian context.
What are the implications for practitioners? It appears that support organisations adequately fulfil the needs of rural patients in the discharge process. LOS does not appear to correlate with the distance of residence from hospital. Practitioners should continue to support and encourage such support networks.
References
[1] Rudd K, Roxon N. New directions for Australian health − taking responsibility: Labor’s plan for ending the blame game on health and hospital care. Canberra: Australian Labor Party; 200 7. Available at http://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id%3A%22library%2Fpartypol%2FGT1O6%22 [verified 5 August 2012][2] Australian Bureau of Statistics. Australian standard geographical classification: statistical geography, Volume 1. Canberra: Australian Bureau of Statistics; 2001. Available at http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features30Mar+2011 [verified 3 August 2012]
[3] Australian Bureau of Statistics. Australian social trends: health outside major cities. Canberra: Australian Bureau of Statistics; 2011. Available at http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features30Mar+2011 [verified5 August 2012]
[4] Strong K, Trickett P, Titulaer I, Bhatia K. Health in rural and remote Australia. Canberra: Australian Institute of Health and Welfare; 1998. Available at http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442459024 [verified 6 August 2012]
[5] Leukemia Foundation. Services; 2011. Available at http://www.leukaemia.org.au/web/services/ [verified 15 August 2011]
[6] Angel Flight. About Angel Flight; 2003. Available at http://www.angelflight.org.au/aboutus/briefingpaper.cfm [verified15 August 2011]
[7] World Health Organization. ICD-10 International Classification of Diseases. Geneva: World Health Organization; 2010. Available at http://apps.who.int/classifications/icd10/browse/2010/en [verified 20 June 2011]
[8] Australian Federal Government. DoctorConnect: Australian standard geographical classification – Remoteness Area. Canberra: Department of Health and Ageing; 2008. Available at http://www.health.gov.au/internet/otd/Publishing.nsf/Content/RA-intro [verified 20 July 2011]
[9] Telstra. Whereis: map of New South Wales. Canberra: Sensis; 2010. Available at http://www.whereis.com/nsw#session=NDQ= [verified 25 July 2011]
[10] Santella A, Shi L, Campbell C. Factors associated with hospital LOS among HIV-infected adults in Louisiana. J La State Med Soc 2010; 162 325–32.
| 21294489PubMed |
[11] Cafarella N. The effect of hospital characteristics on length of stay and charges for pediatric asthma patients. Washington: Georgetown University; 2008.
[12] Liu Y, Phillips M, Codde J. Factors influencing patients’ length of stay. Aust Health Rev 2001; 24 63–70.
| Factors influencing patients’ length of stay.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MvltV2mtA%3D%3D&md5=bef7a0b925dbf0cdf97f4a89d5e5e803CAS | 11496473PubMed |
[13] Lee A, Codde J. Determinants of length of stay: implications on differential funding for rural and metropolitan hospitals. Aust Health Rev 2000; 23 126–33.
| 1:STN:280:DC%2BD3M3gs1yhsA%3D%3D&md5=371e687eb3df2efd3a57f29350453396CAS | 11256259PubMed |
[14] Ortega H, Velden H, Krause E, Reid S. Traumatic deaths in children: is there a difference between urban and rural populations? Pediatr Emerg Care 2013; 29 36–8.
| Traumatic deaths in children: is there a difference between urban and rural populations?Crossref | GoogleScholarGoogle Scholar | 23283260PubMed |
[15] Dwyer J, Kelly J, Willis E, Glover J, Mackean T, Pekarsky B, et al. Managing two worlds together: city hospital care for country aboriginal people-project report. Melbourne: The Lowitja Institute; 2011.
[16] Lawrence M, Dodd Z, Mohor S, Dunn S, de Crespigny C, Power C, et al. Improving the patient journey: achieving positive outcomes for remote Aboriginal cardiac patients. Darwin; Cooperative Research Centre for Aboriginal Health; 2009.
[17] Department of Health and Ageing. A healthier future for all Australians. Final report. Canberra; National Health Reform; 2009.
[18] National Rural Health Alliance Australia’s health system needs re-balancing: a report on the shortage of primary care services in rural and remote areas. Aust J Rural Health 2011; 1–40.
| 21265916PubMed |
[19] Health Issues Centre. The needs of Victorian rural consumers who travel to Melbourne hospitals. Bundoora; La Trobe University; 2008.
[20] Webber K. General practice hospital integration in rural and remote Australia: summary of findings. Canberra: Australian Rural Health Education Network; 2003.
