Trends in Length of Stay and Short-Term Outcomes among Medicare Patients Hospitalized for Heart Failure: 1993–2008

By H. Bueno, J. Ross, Yun Wang, Jersey Chen, M. Vidán, Sharon-Lise T. Normand, J. Curtis, E. Drye, J. Lichtman, P. Keenan and 2 more. Journal of the American Medical Association (JAMA), 2010

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Context For more than a decade, hospitals have focused on decreasing length of stay but this focus may have had unanticipated effects on patient care. Objective To describe the temporal changes in length of stay, discharge disposition, and short-term outcomes among older patients hospitalized for heart failure. Methods Observational study of Medicare fee-for-service hospitalizations for heart failure between 1993 and 2008, with a 30-day follow-up. Main Outcome Measures Length of hospital stay, in-patient and 30-day mortality, and 30-day readmission rates. Results Between 1993 and 2008, 7,799,788 hospitalizations were studied. Length of stay decreased from 8.8 (95% CI, 8.8–8.8) to 6.3 (95% CI, 6.3–6.3) days. In-hospital mortality decreased by half, from 8.5% (95%CI, 8.4–8.6) in 1993 to 4.2% (95%CI, 4.2–4.3%) in 2008, whereas 30-day mortality decreased by 17%, from 12.8% (95%CI, 12.8–12.9%) to 10.9% (95%CI, 10.8–10.9%). Rates of discharge to home decreased 10% (from 74.4% to 66.9%), while discharges to skilled nursing facilities increased 65%, from 13% to 21.3%. Thirty-day readmission rates increased 27%, from 17.2% (95%CI, 17.1–17.3%) relative to 21.9% (95%CI, 21.8–22.0%) (all p values <0.001). Consistent with our unadjusted analyses, 2007–2008 risk-adjusted 30-day mortality risk was 0.86 (95% CI, 0.86–0.87) when compared with 1993–1994, while the 30-day readmission risk ratio was 1.19 (95%CI, 1.18–1.21). Conclusions For patients admitted with heart failure over the past 16 years, we observed reductions in length of stay and in-hospital mortality, less marked reductions in 30-day mortality, and increases in 30-day readmission rates and use of skilled nursing facilities after discharge.

Subfields: Cardiology and Cardiovascular Medicine

View Paper: https://www.semanticscholar.org/paper/d2e2b634c80c5ba2ddbe8708103b7706b3990243

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In Cardiology and Cardiovascular Medicine

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  3. J. Januzzi
  4. C. Yancy
  5. M. Drazner
  6. Véronique L. Roger
  7. M. Gheorghiade

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