The Relationship Between the Follow-up to Discharge Ratio and Length of Stay

OBJECTIVES: Average length of stay (ALOS) is used as a measure of the effectiveness of care delivery and therefore is an important operational measure when evaluating both the hospitalist group and individual hospitalist performance. No metric within the control of the individual hospitalist has been identified to support the individual hospitalist's contribution to the hospitalist group's ALOS goals. This study's objective was to evaluate the correlation between the follow-up to discharge ratio (F:D ratio) and ALOS and assess the relationship between F:D ratio and hospitalist experience. STUDY DESIGN: We systematically evaluated the relationship between hospitalist-level billing data for daily inpatient follow-up encounters and discharge visits (F:D ratio) and the attributed ALOS across consecutive hospitalist encounters at a tertiary care center. RESULTS: Over the study period of 10 quarters from 2017 to 2019, there were 103,080 follow-up or discharge inpatient encounters. The mean (SD) provider F:D ratio and ALOS were 3.94 (0.36) and 4.45 (0.24) days, respectively. The mean (SD) case mix index (CMI) was 1.68 (0.04). There was a strong linear relationship between the F:D ratio and both ALOS and CMI-adjusted ALOS (r = 0.807; P =.014; and r = 0.814; P =.001, respectively). The mean (SD) F:D ratio for hospitalists with 1 year or less of experience compared with those with more than 1 year of experience was 4.23 (0.80) vs 3.88 (0.39), respectively (P =.012). CONCLUSIONS: A strong linear relationship exists between the F:D ratio and ALOS. Additionally, the F:D ratio improves with experience. Provider-level billing data applied as the F:D ratio can be used as a hospitalist management and assessment tool.