Study 2018-15 (HSR) Shifting care from inpatient towards day-care and ambulatory care: impact on readmission rates & post-discharge mortality

Ongoing study - As in most Western countries, also in Belgium, a strong pressure exists on hospitals to increase efficiency by reducing the length of stay (LOS) of inpatient care and/or substitution of inpatient by day-care admissions. Many hospitals introduced care pathways to decrease length of stay and eliminate inefficiencies in the care process. Simultaneously with this policy priority to improve hospital efficiency, quality improvement initiatives were increasingly undertaken. Yet, length of stay reduction and substitution from inpatient towards day- care might be negatively influence quality indicators such as hospital readmission and 30-day mortality rates. Moreover, it is possible that hospitals shift care outside the hospital setting without alternatives set in place. The current KCE-study includes three main study parts. First, we will analyse the hospital discharge data (2008-2021) to study if there has been a trade-off between LOS reduction and substitution from inpatient to day-care on one hand and hospital readmissions and post-discharge mortality on the other hand. The study will include hospital-wide (e.g. all-cause readmissions) and condition-specific indicators (e.g. readmissions for a selection of medical conditions and surgical procedures). Second, a literature review will be conducted to evaluate the effectiveness of interventions that aim to promote early discharge and prevent hospital readmissions and post-discharge mortality. Third, focus groups (healthcare professionals, patient representatives, policy makers) will be set up to evaluate, with input from the first two study parts, which conditions or interventions are required to ensure reductions in LoS and substitution towards day-care are not made at the expenses of quality of care.