Unnecessary, Avoidable Lengths of Stay: a Strategy for Clinician Empowerment and Effectiveness Evaluation

Study Overview
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Brief Summary
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Background: In recent years an increasing trend in excessive lengths of stay has been recorded at the Parma University Hospital, compared with regional mean values. Excessive lengths of stay have been demonstrated to constitute not just an economic problem, but also a clinical and public health issue. Since the measures taken at our institution so far have not proven effective, the investigators carried out a literature review, which mostly detected observational studies, restricted to the assessment of the impact of a single intervention. Objectives: This project intends to evaluate the effectiveness of a multifaceted strategy aiming to empower clinicians on the issues associated with excessively long and avoidable hospital stays, and enable them to identify corrective measures (according to the principles of clinical governance). Study design: cluster-randomized, parallel group, open-label, community trial Methods: trained personnel will periodically record causes for excessive lengths of stay in all participating wards using an ad hoc data collection sheet. In the wards randomized to the experimental group, interventions aimed to clinician empowerment - provision of reminders and periodical audits - will be implemented. Expected results: A reduction in the experimental vs. the control arm unnecessary lengths of stay is expected, although the introduced measures will also presumably lead to improvement in the wards where they are not implemented.

Official Title
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Unnecessary, Avoidable Lengths of Stay: a Strategy for Clinician Empowerment and Effectiveness Evaluation

Conditions
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Hospitalization, Length of Stay

Intervention / Treatment
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* Behavioral: Multicomponent strategy to reduce avoidable length of stay
* Other: No intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients present on the participating wards during one of 12 randomly selected index days (one for each month of data collection) Exclusion Criteria: patients admitted or discharged on the index days patients with length of stay (interview date - admission date) > 90 days
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br> | Behavioral: Multicomponent strategy to reduce avoidable length of stay<br>* The strategy comprises two integrated components: Distribution of two monthly reports, one consisting in the list of patients who, through data collection performed, are classified to be present on the ward although their clinical status is considered compatible with discharge; the other featuring individual length of stay profiles for each physician operating in the intervention arm (information taken from administrative data), allowing comparisons with the rest of the medical staff; Audits performed by professionals of each ward of the intervention arm designed to discuss cases judged to be compatible with discharge. The organization of this work are left to the wards, without any interference from the project team.<br>|
| Other: Control<br>No Intervention | Other: No intervention<br>* No interventions (reporting, auditing) are planned; nevertheless control ward physicians know study aims and are informed about their patient's data collection.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of patient-days compatible with discharge |  | 12 month period [02/2008 - 02/2009] +1 follow up month [02/2010] | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall length of stay (in days) | Overall length of stay = discharge date - admission date | 12 month period [02/2008 - 02/2009] | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Public health, Policy, Training