Article

Methodological challenges arise when one uses various Veterans Health
Administration (VHA) data sources, each created for distinct purposes, to
characterize length of stay (LOS). To illustrate this issue, we examined how
algorithm choice affects conclusions about mental health condition (MHC)-related
differences in LOS for VHA patients with diabetes nationally (n = 784,321). We
assembled a record-level database of all fiscal year (FY) 2003 inpatient care. In
10 steps, we sequentially added instances of inpatient care from various VHA
sources. We processed databases in three stages, truncating stays at the
beginning and end of FY03 and consolidating overlapping stays. For patients with
MHCs versus those without MHCs, mean LOS was 17.7 versus 13.6 days, respectively
(p < 0.001), for the crudest algorithm and 37.2 versus 21.7 days, respectively (p
< 0.001), for the most refined algorithm. Researchers can improve the quality of
data applied to VHA systems redesign by applying methodological considerations
raised by this study to inform LOS algorithm choice.

Langue : ANGLAIS