Hospital length of stay (LOS) is a central factor in the increasingly important and complex interplay between quality of healthcare delivery and medical costs. The inpatient environment bolsters the intensity of care, and indeed longer hospital stays have been associated with a lower incidence of adverse outcomes leading to readmissions. However, the hospital is also an exceptionally expensive care delivery environment, both financially and in terms of nosocomial illness and iatrogenic risk, such that unnecessarily prolonged stays can precipitate higher costs and lower quality of care. Our research focuses on uptake of comparative effectiveness research (CER) for the discharge decision in patients who have undergone complex surgical resections for GI malignancy at Emory Healthcare. We will study how well hospital discharge decisions in recent practice conform to the CER and experiment with an alternative choice architecture designed to promote better CER uptake for the discharge decision. The design that we propose builds on behavioral economics knowledge.
It aims at introducing a new default and a reference point, determined by CER, while at the same time preserving physicians'medical authority and freedom of choice. Currently, the default option is """"""""no discharge"""""""" unless a practitioner makes an affirmative decision to discharge the patient. We propose to change it to """"""""discharge"""""""" once all CER criteria are satisfied. However, the physician has the right to overthrow the default discharge decision if (s)he feels so. However, if this is the case, a medical justification for doing so needs to be documented. We hypothesize that providing practicing physicians with CER discharge criteria in a highly available IT format and changing from the current standard discharge practice to the alternative default option will significantly increase uptake of the CER criteria for discharge.
Hospital length of stay is a central factor in the complex interplay between quality of healthcare delivery and medical costs. Our research focuses on the uptake of comparative effectiveness research (CER) for the discharge decision in patients who have undergone complex surgical resections for GI malignancy at Emory Healthcare. We will study how well hospital discharge decisions in recent practice conform to the CER and experiment with an alternative choice architecture designed to promote better of CER uptake for the discharge decision.
