Lien précarité – durée et complexité des séjours hospitaliers en secteur de court séjour

Background. - Several studies have shown that socioeconomic deprivation is associated with increased hospitalization lengths of stay (LOS) and costs. Yet, the French DRG-based information system (PMSI) does not take deprived situations into account. Hence, we aimed at extracting routinely available variables measuring deprivation from the Hospital Information System and at assessing their association with severity of illness and hospital LOS. Methods. - We performed record linkage between the PMSI database concerning stays of patients aged more than 16 years in the short-stay sector of Assistance publique-Hopitaux de Paris in 2007 and an administrative database which provided the following deprivation measures: recipients of Couverture Medicale Universelle (basic or complementary health insurances adapted for underprivileged French citizens) or Aide Medicale d'Etat (health and medical emergency insurances adapted for underprivileged non French citizens living in France) and homeless patients. We compared length of stays showing a deprivation measure to others after adjustment on morbidity, age and sex. Results. - Among 352,721 stays, the prevalence of the deprivation measures ranged from 0.71% for "homelessness" to 6.24% for complementary Couverture Medicale Universelle. Stays showing a deprivation measure had specific illnesses and had more frequently associated comorbidities or complications than others. After adjustment, deprivation measures were associated with significantly increased LOS (by 5% for Couverture Medicale Universelle, to 48% for emergency Aide Medicale d'Etat. Conclusion. - Routine extraction of deprivation measures from Hospital Information Systems is feasible. Age. sex and illness being equal, these deprivation measures were associated with more complicated cases and increased LOS. We recommend that case mix-based hospital prospective payment systems take socioeconomic deprivation into account. (C) 2009 Elsevier Masson SAS. All rights reserved.