The evaluation of screening methods to identify medically unnecessary hospital stay for patients with pneumonia

Objectives: This study compared three methods to screen charts of pneumonia patients for excess days. Methods: A derivation data set was used to statistically derive a severity measure to predict length of stay for pneumonia patients and to refine a clinical algorithm for identifying excess stay. A validation data set was used to compare three computerized methods to screen for unnecessary hospital days: (1) an observed length of stay greater than a target value; (2) an observed stay greater than predicted for the specific patient; and (3) an algorithm that tested whether there were clinical justifications for the entire hospital stay. Results: The sensitivity and specificity for detecting excess stay for the three methods were (1) 0.48 and 0.85 for the observed stay greater than the target value; (2) 0.56 and 0.73 for observed stay greater than predicted; and (3) 0.83 and 0.85 for the algorithm. Conclusions: These results suggest that computerized clinical algorithms may provide a useful method to detect unnecessary hospital stay.