Acute care hospital utilization by patients with visual impairment

Objective: To assess whether visual impairment contributes to average length of stay (ALOS) within inpatient care facilities. Methods: We used the New York State Department of Health's Statewide Planning and Research Cooperative System (SPARCS) data for 1993, containing 1 principal diagnosis code and up to 8 secondary diagnosis codes for approximately 2.6 million hospital discharges. We evaluated ALOS differences in patients with and without visual impairment and in patients with eye pathologic conditions, including eye surgery. Visual impairment is not a primary admitting diagnosis, but may be coded as a secondary diagnosis. Eye pathology comprises a large variety of conditions, including corneal ulcers, abscesses, corneal deposits, edema, cataracts, vitreous hemorrhages, and many other eye disorders (ICD-9-CM codes 360-368.9 and 370-379). Results: The ALOS was 13.4 days for patients with visual impairment (N = 5764), 11.9 days for patients with either eye pathology or visual impairment (N = 60 085), and 8.2 days for patients with no visual impairment (N = 2 546 586). Using a series of multivariate models that controlled for the variables of age, sex, and payer source, as well as disease, disorders, and ophthalmology procedures, we found that the existence of visual impairment added 2.4 days to the ALOS (P<.001), while eye pathology combined with a secondary diagnosis of visual impairment added 1.8 days to the ALOS (P<.001). Conclusions: Visual impairment contributes significantly to hospital length of stay. A better understanding of the functional care needs of patients with visual impairment in an acute care setting and at the time of discharge from the hospital may contribute to reducing excess ALOS and its related costs while improving the quality of patient care.