Inpatient Tertiary-Care Utilization
Authors:   , Orr Jacquelynn Yvonne , Gold Marla , Buehler James W 
Published: March 2022

There are numerous options and locations within the U.S. healthcare continuum, including inpatient (IP) tertiary-care hospitals where individuals can obtain treatment and services for serious acute medical and behavioral health conditions. After the Patient Protection and Affordable Care Act was enacted, more funding and research in areas other than IP care have been the focus. The purpose of this mixed-methods sequential explanatory study was to explore national IP hospital utilization from 2010 to 2015. Specifically, IP discharges with diabetes mellitus (DM), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and a behavioral health comorbidity of mood disorders. An analysis of the Healthcare Costs and Utilization Project (HCUP) National (Nationwide) Inpatient Sample (NIS) data from 2010 to 2015 was conducted to evaluate the operational outcomes: length of stay, total charges, and total costs. Those data were then used as part of structured interviews with 11 hospital administrators to obtain additional insight about IP healthcare delivery and the decision-making process for patient treatment and discharge. Length of stay was found to be about one day longer for discharges with mood disorders when controlling for other covariates. Length of stay was found to be about one day longer after the ACA implementation (years 2014 &2015). Total charges for discharges with mood disorders when controlling for other covariates were 1% lower for DM, 1% higher for CHF, and 4% higher for COPD. Total charges for discharges after the ACA implementation (years 2014 &2015) were 18% higher for DM, 12% higher for CHF, and 13% higher for COPD. Total costs for discharges with mood disorders when controlling for other covariates were 0.4% higher for DM, 2% higher for CHF, and 4% higher for COPD. Total costs for discharges after the ACA implementation (years 2014 &2015) were 7% higher for DM, 2% higher for CHF, and 3% higher for COPD. The following main qualitative themes emerged: numerous types of resources are essential, various persuading factors influence administrators' decision-making process, and the use of information (both internal and external) is helpful to improving delivery of care. Supplementary Materials Description Supplement 1: Descriptive Characteristics of Adult Unweighted Discharges from the 2010 to 2015 HCUP National (Nationwide) Inpatient Sample (NIS) for Diabetes, Congestive Heart Failure, and Chronic Obstructive Pulmonary Disease (Tables S1-1 through S1-18) Supplement 2: Cross-Sectional Analysis of 2010 to 2015 HCUP National (Nationwide) Inpatient Sample (NIS) Outcomes (length of stay, total charges and total costs) for Diabetes, Congestive Heart Failure, and Chronic Obstructive Pulmonary Disease (Full Models) (Tables S2-1 through S2-6) Supplement 3: Trend Analysis Results (Fixed and Random Effects) of 2010 to 2015 HCUP National (Nationwide) Inpatient Sample (NIS) Outcomes (length of stay, total charges and total costs) for Diabetes, Congestive Heart Failure, and Chronic Obstructive Pulmonary Disease (Stepped Full Mixed Model)