The relationship between increased hospital length of stay and accessibility to care settings with lower levels of complexity in italy
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Emergency Department SS. Trinità Hospital, ASL Cagliari Italy
Department of Medicine, Surgery and Pharmacy, University of Sassari Italy
University Hospital Company of Sassari (AOU Sassari) Italy
PhD School in Biomedical Sciences (Public Health), University of Sassari Italy
Paolo Castiglia
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A1968
Background and objective:
Hospital length of stay could be increased (outlier) where alternative beds that facilitate care at discharge from the acute care unit are lacking. This study aims to evaluate the potential relationship between hospital outlier and the accessibility to less complex care settings.

A correlational study was conducted on ordinary hospital admissions in the year 2019 (using the Ministry of Healths Hospital Discharge Records Report) and hospital post-acute (long-term care and rehabilitation) and territorial (residential, semi-residential and rehabilitation) beds in Italy. In respect to the national average outlier, the twenty Italian regions were classified into two groups: with higher and with lower percentages of outliers.

Out of a total of 6.020.466 ordinary hospitalizations in Italy, the average outlier was 3.9%, with a range among regions between 2.7% and 4.7%. The national average of territorial beds per inhabitant was 0.60% (range 0.15%-0.99%). The relationships between outlier and territorial beds are always opposite between the two groups and mainly weak, except for semi-residential beds in the group with lower outlier rates where it is moderate (Pearsons r= –0.583; Spearmans Rho= –0.766, p=0.027). The national average of post-acute hospital beds was 0.06% (range 0.02%-0.10%). Correlations between outliers and post-acute hospital beds are always direct in the groups, except for long-term care hospital beds in the group with higher outlier rates (Pearsons r= –0.306). The strongest relationship is between outlier and hospital rehabilitation beds in the group with lower outlier percentages (Pearsons r= –0.720, p=0.044).

These data show that the decrease in outlier correlates with the increase in territorial semi-residential beds and hospital rehabilitation beds, while the increase in outlier correlates with the decrease in hospital long-term care beds. Considering the inhomogeneous distribution of less complex care settings in Italy, further investigations are needed, especially on the deficient regions.