Practice variation and length of stay in alcohol and drug detoxification centers

Received 29 December 2003; received in revised form 9 July 2004; accepted 24 September 2004.

Abstract

Admissions to 20 publicly funded alcohol and drug detoxification centers in Massachusetts were examined to identify program and patient variables that influenced length of stay. The last admission during fiscal year 1996 was abstracted for patients 18 years of age and older seeking alcohol, cocaine, or heroin detoxification (n = 21,311; 29% women). A hierarchical generalized linear model examined the effects of patient and program characteristics on variation in length of stay and tested case-mix adjustments. Program size had the most influence on mean adjusted length of stay; stays were more than 40% longer in detoxification centers with 35 or more beds (7.69 days) than in centers with less than 35 beds (5.42 days). The study highlights the contribution of program size to treatment processes and suggests the need for more attention to program attributes in studies of patient outcomes and treatment processes.

Keywords: Detoxification, Length of stay, Program size

a Department of Mathematics and Statistics, Mississippi State University, Mississippi State, MS 39762, USA

b Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR 97201, USA

c The Lewin Group Falls Church, VA 22042, USA

d Department of Health Care Policy, Harvard Medical School Department of Biostatistics, Harvard School of Public Health Boston, MA 02115, USA

e Rambam Medical Center, Psychiatric Division, Outpatient Clinic, Ministry of Defense Project, Haifa 31096, Israel

Corresponding author. Dept. of Public Health & Preventive Medicine, CB669, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA. Tel.: +1 503 494 1177; fax: +1 503 494 4981

PII: S0740-5472(04)00122-9

doi:10.1016/j.jsat.2004.10.002

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