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Multicenter Study
. 2009 Nov;2(6):548-57.
doi: 10.1161/CIRCOUTCOMES.108.825612. Epub 2009 Oct 13.

Looking forward, looking back: assessing variations in hospital resource use and outcomes for elderly patients with heart failure

Michael K Ong  1 , Carol M Mangione, Patrick S Romano, Qiong Zhou, Andrew D Auerbach, Alein Chun, Bruce Davidson, Theodore G Ganiats, Sheldon Greenfield, Michael A Gropper, Shaista Malik, J Thomas Rosenthal, José J Escarce
Affiliations
Multicenter Study

Looking forward, looking back: assessing variations in hospital resource use and outcomes for elderly patients with heart failure

Michael K Ong et al. Circ Cardiovasc Qual Outcomes. 2009 Nov.

Abstract

Background: Recent studies have found substantial variation in hospital resource use by expired Medicare beneficiaries with chronic illnesses. By analyzing only expired patients, these studies cannot identify differences across hospitals in health outcomes like mortality. This study examines the association between mortality and resource use at the hospital level, when all Medicare beneficiaries hospitalized for heart failure are examined.

Methods and results: A total of 3999 individuals hospitalized with a principal diagnosis of heart failure at 6 California teaching hospitals between January 1, 2001, and June 30, 2005, were analyzed with multivariate risk-adjustment models for total hospital days, total hospital direct costs, and mortality within 180-days after initial admission ("Looking Forward"). A subset of 1639 individuals who died during the study period were analyzed with multivariate risk-adjustment models for total hospital days and total hospital direct costs within 180-days before death ("Looking Back"). "Looking Forward" risk-adjusted hospital means ranged from 17.0% to 26.0% for mortality, 7.8 to 14.9 days for total hospital days, and 0.66 to 1.30 times the mean value for indexed total direct costs. Spearman rank correlation coefficients were -0.68 between mortality and hospital days, and -0.93 between mortality and indexed total direct costs. "Looking Back" risk-adjusted hospital means ranged from 9.1 to 21.7 days for total hospital days and 0.91 to 1.79 times the mean value for indexed total direct costs. Variation in resource use site ranks between expired and all individuals were attributable to insignificant differences.

Conclusions: California teaching hospitals that used more resources caring for patients hospitalized for heart failure had lower mortality rates. Focusing only on expired individuals may overlook mortality variation as well as associations between greater resource use and lower mortality. Reporting values without identifying significant differences may result in incorrect assumption of true differences.

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Conflict of interest statement

Disclosures

The authors report no conflicts.

Figures

Figure 1
Figure 1
Looking Forward Cohort Inpatient, 30-Day, and 180-Day Mortality Rates
Figure 2
Figure 2
180-Day Total Hospital Days for the Looking Back and Looking Forward Cohorts
Figure 3
Figure 3
180-Day Indexed Total Direct Costs for the Looking Back and Looking Forward
Figure 4
Figure 4
180-Day Total Hospital Days for the Looking Back and Looking Forward Cohorts
Figure 5
Figure 5
180-Day Indexed Total Direct Costs for the Looking Back and Looking Forward Cohorts
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References

    1. Dartmouth Atlas of Health Care. The Care of Patients with Severe Chronic Illness. Hanover, NH: Center for the Evaluative Clinical Sciences, Dartmouth Medical School; 2006.
    1. Dartmouth Atlas of Health Care. Tracking the Care of Patients with Severe Chronic Illness. Lebanon, NH: The Dartmouth Institute for Health Policy and Clinical Practice; 2008. - PubMed
    1. Wennberg JE, Fisher ES, Baker L, Sharp SM, Bronner KK. Evaluating The Efficiency Of California Providers In Caring For Patients With Chronic Illnesses. Health Affairs (Millwood) 2005;(Supplemental Web Exclusives):526–43. - PubMed
    1. Brownlee S. Overtreated. New York: Bloomsbury USA; 2007.
    1. New York Times Editorial. Quality Care at Bargain Prices. New York Times; 2008.

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