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June 21, 2017

In hospitals, good health can be contagious, research suggests

Daily Briefing

Hospital patients need less care and are safely discharged sooner when they are paired with a healthier roommate, according to new research, Austin Frakt writes for the New York Times' "The Upshot."

Building the hospital of the future

The observational study, published in the American Journal of Health Economics, involved around 3,800 patients and their roommates at a single hospital in Connecticut. Patients participating in the study included individuals recovering from surgery as well as patients with medical conditions such as cancer or pneumonia. The study did not involve patients with single rooms.

Key findings

The study found that, compared with the patient with the sickest roommate, the patient with the healthiest roommate required about one-quarter less medical attention and spent about eight fewer hours in the hospital—saving the hospital about $840 overall. Further, for female patients, having a healthier roommate correlated with a better condition at time of discharge and a reduced chance of re-hospitalization.

According to Frakt, the study rules out what Frakt calls the "apparently obvious explanation" for the findings: namely, that patients are assigned roommates "of [a] similar condition"—meaning that patients with relatively healthy roommates are likely to be relatively healthy themselves. In fact, the study found that even in a specific room and among patients with a specific diagnosis, patients with healthier roommates "fared better," Frakt writes.

Moreover, study author Olga Yakusheva, a University of Michigan economist, noted that "placing a sick and a healthy patient in one room benefited the sicker patient without ill effects for the healthier roommate."

Overall, the hospital could have reduced inpatient days by about 900 per year and saved about $1 million if it had assigned patients based on the phenomenon observed in the study, Frakt reports.

Pushing back on the single-occupancy trend

According to Frakt, the study suggests a downside to the trend among U.S. hospitals to establish more single-occupancy rooms. Research suggests that many patients prefer a single-occupancy room, Frakt writes, and the per-patient amount of hospital room space has increased twofold since the late 1980s. Further, some research suggests that housing patients in individual rooms curbs the spread of flu.

But despite those risks and patient preferences, the latest study aligns with research suggesting that patients fare better when they have a roommate.   

According to Frakt, there are several possible explanations for why a healthier hospital roommate has a positive influence. For instance:

  • A healthier roommate could share self-care knowledge or offer assistance, research shows;
  • A healthier roommate require less nursing attention, thereby freeing up that attention for the sicker patient;
  • Patients might feel better when they see someone else doing well; and
  • Patient interactions can reduce anxiety, studies have found.

Ultimately, Frakt writes, the findings are just one example of "peer effects," or the tendency for a behavior to spread through social interaction. Research also has found that smoking, obesity, and alcohol consumption spread among social networks, Frakt writes. 

So how can patients and hospitals leverage the study findings? While patients might be able to request a room change to boost the odds of getting a healthier roommate, Frakt writes that a more effective route "might be for hospital staff to systematically take the phenomenon into account when assigning patients to rooms" (Frakt, "The Upshot," New York Times, 6/19).

Building the hospital of the future

The hospital of the future

The fundamental assumptions underpinning traditional acute care strategy are becoming increasingly weaker—which means current hospitals aren't suitable for future market demands.

To achieve acute care sustainability, organizations have to shift focus from labor, supply cost, and clinical variation to the challenge with the greatest savings potential: fixed costs. This white paper shares tactics for significantly restructuring fixed costs by reallocating services across the system and rightsizing excess inpatient capacity.

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