Patient Flow in California’s Hospitals: Where Did Patients Come From, How Long Did They Stay, Where Did They Go and Why Were They There?
In 2024, a majority of statewide admissions were from a home or other non-healthcare setting (71.3%, not counting admissions related to childbirth). A majority of statewide discharges were routine discharges (65.3%).
Introduction
The Patient Flow in California’s Hospitals report shows the number of encounters, and the percentage of all encounters, associated with each patient point-of-origin (where the patient came from) and disposition (where the patient went) category, as well as the median length of stay, for either the selected hospital or all hospitals statewide in 2024, depending on the filter selection. Hovering over any point-of-origin or disposition category will display a tooltip that shows the top five diagnosis types—based on Major Diagnostic Categories (MDCs)—for that category. Each MDC corresponds to a major organ system (e.g., respiratory system, circulatory system, digestive system) rather than a specific disease (e.g., cancer, sepsis). When a single hospital is selected, the tooltip will also show the percentages of all statewide and countywide encounters associated with that category and hospital.
The arrows in the visualization compare the 2024 percentages to the 2023 percentages for each of the point-of-origin and disposition categories. A blue up arrow represents an increase in percentage from 2023 to 2024, an orange down arrow represents a decrease in percentage between those years, and a grey equal sign represents no change in the percentage. Hovering over the arrows or equal signs will display the 2023 counts and percentages. Hovering over the Overall Median Length of Stay will display the Median Length of Stay by Type of Care in the tooltip. Type of Care is the kind of licensed bed that patients occupy, which defines the level and nature of services they receive (i.e. Acute Care, Skilled Nursing/Intermediate Care, Psychiatric Care, Chemical Dependency Recovery Care, or Physical Rehabilitation Care.)
Key Findings
- 10.6% of statewide admissions were newborns.
- Statewide, leaving against medical advice (2.3% of all discharges) was as common as inpatient death (2.3% of all discharges).
- Statewide, Acute Care patients had the shortest median length of stay (3 days) while Psychiatric Care patients had a median length of stay more than twice as long (7 days).
- Infectious & Parasitic Diseases, Systemic or Unspecified Sites was the most common diagnosis category for patients who were transferred to other types of facilities and those who were discharged to home health care. It was also the most common diagnosis category for cases that ended in inpatient death.
Visualization
*SNF refers to Skilled Nursing Facility, ICF to Intermediate Care Facility, and IRF to Inpatient Rehabilitation Facility.
Note: The arrows reflect the year-over-year change in the percentage within each category, not the change in the count. It is possible for the percentage to decrease even when the count increases year over year within that same category. This happens when the overall number of encounters grows faster than the number of encounters in that category.
How HCAI Created This Product
The Patient Flow in California’s Hospitals report is based on the point of origin, length of stay, disposition and diagnosis data reported to HCAI in the 2024 Patient Discharge Data. This dataset contains a record for each inpatient discharge from a hospital licensed by the California Department of Public Health (CDPH). The term “hospital” refers to a healthcare facility licensed to operate inpatient beds and offer 24-hour inpatient care. CDPH licenses four types of hospitals: general acute care hospitals, acute psychiatric hospitals, chemical dependency recovery hospitals, and psychiatric health facilities.
To protect patient personal information, the California Health and Human Services Agency has adopted a policy of statistically masking or de-identifying sensitive data (CalHHS Data De-Identification Guidelines). In this report, to protect patient identity, if a point-of-origin or disposition category for a hospital has fewer than 11 encounters, the top five Major Diagnostic Categories (MDCs) for that category are not shown. In addition, when the number of encounters in the newborn category is less than 11, the count is masked and the percentage set to 0.
More information about the 2024 Patient Discharge Data and a list of MDCs can be found in the 2024 Complete Data Documentation on HCAI’s Data Documentation page.
Methods for Creating Point of Origin & Disposition Categories
Both the patient type of admission and point of origin were used to identify from where the patient came, and the patient disposition was used to identify where the patient went after discharge.
| Point of Origin Category | Source of Admission(s) included |
|---|---|
| Newborns | Admission Type = Newborn |
| From Home/Non-Health Care Setting | Point of Origin = Non-Healthcare Facility |
| Point of Origin = Court/Law Enforcement | |
| From Hospital or Surgical Setting | Point of Origin = Clinic or Physician’s Office |
| Point of Origin = Hospital (Different Facility) | |
| Point of Origin = Ambulatory Surgery Center | |
| From Other Healthcare Settings | Point of Origin = Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), or Inpatient Rehabilitation Facility (IRF) |
| Point of Origin = Another Health Care Facility | |
| Point of Origin = One Distinct Unit to another Distinct Unit of the Same Hospital | |
| Point of Origin = Hospice |
| Disposition Categories | Disposition(s) Included |
|---|---|
| Routine Discharge | Disposition = Discharged to home or self-care |
| Disposition = Discharged/transferred to court/law enforcement | |
| Transferred to a Short-term Hospital | Disposition = Discharged/transferred to a short-term general hospital for inpatient care |
| Transferred to Other Type of Facility (Including Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), and Inpatient Rehabilitation Facility (IRF)) | Disposition = Discharged/transferred to skilled nursing facility (SNF) with Medicare certification in anticipation of skilled care |
| Disposition = Discharged/transferred to a facility that provides custodial or supportive care (includes Intermediate Care Facility) | |
| Disposition = Discharged/transferred to an inpatient rehabilitation facility (IRF) including a rehabilitation distinct part unit of a hospital | |
| Discharged to Home Health Care (HHC) | Disposition = Discharged/transferred to home under care of an organized home health service organization in anticipation of covered skilled care |
| Left Against Medical Advice (AMA) | Disposition = Left against medical advice or discontinued care of an organized home health service organization in anticipation of covered skilled care |
| Inpatient Deaths | Disposition = Expired |
Additional Information
Topic: Healthcare Utilization
Source Link: Healthcare Utilization – Patient-Level Administrative Data
Citation: HCAI — Patient Discharge Data – Hospital Inpatient – Patient Flow in California’s Hospitals: Where Did Patients Come From, How Long Did They Stay, Where Did They Go and Why Were They There
Temporal Coverage: 2023–2024
Geographic Granularity: Hospital
Spatial/Geographic Coverage: Statewide
Frequency: Annually