Statewide, between 6.9 and 7.8 percent of hospital admissions were waitlisted —that is, remaining in the hospital after the need for acute care ceases—over a five year period (2006-2011), according to discharge data analyzed by the Hawaii Health Information Corporation (HHIC), the state’s premier healthcare data collector and analyzer.
Waitlist patients are those needing treatment after hospital discharge, but not at the severity level that requires inpatient care. These patients often continue to stay in a hospital because there are limited available community placement options that meet the patient’s needs.
For Hawaii’s neighbor islands, however, the waitlist patterns are significantly different. On Maui, the rate ranged between 12 and 16 percent, whereas on Kauai, the rates varied between 8 and 10.5 percent. Except for 2007 and 2009 (7.7 and 9.2 percent, respectively), Hawaii Island’s rate was similar to the Oahu rate of 6 to 7 percent.
While there were more waitlisted patients statewide in 2011 than in 2006, they experienced shorter hospital stays, according to the HHIC analysis. Compared to 2006 data, HHIC found that the 2011 average length of stay (ALOS) for waitlisted patients decreased 25 percent, from 21.7 to 16.5 days, across all counties except Maui, which increased 12 percent, from 16.8 to 18.8 days.
However, the ALOS for waitlist patients is still more than the average non-waitlisted patient—nearly four times longer. HHIC found that the risk of a patient being waitlisted increased with age and increased significantly with each decade of life.
Neighbor island hospitals experienced a higher cost and volume of waitlist patients than Oahu with chronic-related disease conditions including chronic obstructive pulmonary disease, degenerative nervous system disorders and diabetes.
Bed availability does not appear to be a problem as there was an 11 percent increase in the number of long-term care beds statewide between 2006 and 2011. Appropriately matching the health needs of a waitlisted patient with a sufficiently staffed bed is likely an issue.
The key barriers to community placement of waitlisted patients include insufficient staff with higher skill-mix in nursing homes and other placement alternatives to meet the needs of those with complex conditions, a lack of specialty equipment to provide appropriate care, the cost of multiple or high-cost antibiotics, and lack of community-based resources to support patients with underlying mentally illness in managing their other medical conditions.
“Our analyses make clear that the waitlist problem exists statewide but that has very special dimensions on each island,” said Peter Sybinsky, Ph.D., president and CEO of HHIC. “Efforts by health plans, hospitals and other providers and community agencies need to take into account this variation as they work together to solve this vexing problem.”
About the Data
Findings are based on data collected from all hospitals across the state, except Tripler Army Medical Center. The report was prepared based on funding provided by Hawaii Medical Service Association, Kaiser-Permanente, AlohaCare, Ohana Healthcare and United Healthcare, in an attempt to provide a clear description of Hawaii’s waitlist population and estimate the financial impact on Hawaii’s hospitals.
About HHIC/Health Knuggets
Established in 1994, HHIC maintains one of the largest comprehensive health care databases in the state, comprised of local and national inpatient, emergency department, ambulatory care, financial data and other data. The research and data compiled are analyzed and disseminated statewide and are used to help shape healthcare policy and educate decision makers, health care providers and industry experts. Through HHIC Knowledge Nuggets, the organization seeks to inform the public about important healthcare topics. For more information, visit www.hhic.org.