TABLE 3.2 Percent Change in Inpatient Community Hospital Utilization, United States, 1994–1995


Percent Change Quarter Ending March 1994–1995



Inpatient admissions


Patients ≥ 65 years


Adjusted admissions


Inpatient days


Length of stay



SOURCE: American Hospital Association, National Hospital Panel Surveys, March Panel, 1994, 1995.

the hospital or into outpatient services, and the pressures to reduce the length of stay stimulated by changes in reimbursement. The increased acuity of patients and the consequent complexity of inpatient hospital care and services require more specialized and intense nursing care than before. This is reflected in the increased use of special care units such as the intensive care units (ICU) in hospitals. The number of staffed beds in ICUs in community hospitals increased by 29 percent between 1983 and 1993. The percentage of total staffed beds that are ICU beds also rose during this period from 7.5 percent to nearly 11 percent in 1993. During the same period acute care beds dropped from nearly 82 percent to 64 percent (see Table 2.4 in Part II of this report).

Continuum of Care

Historically, the primary function of hospitals has been to treat acute illness and injury; prevention of disease and promotion of health have been the domain of the public health system and individual care givers. In the emerging health care system there are incentives to merge these two roles and to organize the entire continuum of care (Shortell et al., 1995). In an effort to maintain patient base as well as to capture market share, hospitals have extended the scope and type of services offered beyond the traditional acute inpatient services. They now emphasize prevention, health promotion, and primary care to a much greater degree than previously.

In responding to the need to reduce costs, hospitals have to some extent shifted the site of care and consequently some of the costs (Table 3.3). Changes in payment policies, incentives to treat patients in less costly sites, and technological advances have contributed to the shift for a growing number of services to

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