Hospital Length-of-Stay, Charges, and Mortality in CHF Patients
Hospital Length-of-Stay, Charges, and Mortality in CHF Patients
The aim of this study was to demonstrate differences in hospitalization outcomes including length-of-stay (LOS), charges, and mortality in congestive heart failure patients using the Healthcare Cost and Utilization Project dataset. Hospitalizations with International Classification of Diseases, Ninth Revision, clinical modification (ICD-9-CM) codes for congestive heart failure were extracted from a 10% random Healthcare Cost and Utilization Project sample to yield 19,693 hospitalizations between January 1 and December 31, 1997. Mean hospital charges were $11,688 and mean LOS was 5.83 days. The overall in-hos-pital mortality rate was 4.7%. Both LOS and hospital charges were higher in urban compared with rural hospitals (p ≤ 0.05). LOS and charges also increased with hospital size (p ≤ 0.05). Among patient characteristics, patient health status significantly affected LOS, charges, and mortality. Privately insured/health maintenance organization patients had 9% shorter LOS than Medicare patients, and Medicaid patients had 6.6% lower charges and 42% lower mortality than Medicare patients (p ≤ 0.05). Other significant predictors of study outcome variables included age, gender, race, hospital region, and hospital experience.
Congestive heart failure (CHF) has become a major public health concern in the United States as a result of increasing prevalence and resource use coupled with technology advances. Due to its age-dependent nature, CHF is the most commonly listed diagnosis in hospitalizations of elderly persons. The estimated annual inpatient costs for CHF exceed $8 billion, annual out-of-pocket expenditures exceed $3 billion, and overall management of heart failure costs $18 billion per year. As baby boomers age and live longer, the prevalence of CHF will increase and consequently increase the financial burden on patients, families, health care systems, and society.
CHF is characterized by increasing hospitalization rates and decreasing survival rates. To address issues of quality and cost of care provided, understanding hospital-related factors that affect CHF outcomes becomes important because hospitalizations represent a major percentage of overall CHF disease cost burden. Hospital characteristics such as for-profit status and teaching/nonteaching status have been shown to affect quality of care and outcomes. Rural community hospitals have been shown to under-prescribe β-blockers and angiotensin-converting enzyme inhibitors in heart failure patients. Hospital size (based on number of beds) has also been shown to influence CHF outcomes. A study by Taylor et al. showed that Medicare payments for CHF patients were higher for patients admitted to for-profit hospitals. The study also showed that teaching hospitals had lower mortality rates compared with for-profit hospitals. The amount of experience in treating heart failure patients (patient volume) has also been shown to affect CHF-related hospitalization outcomes.
Studies have shown that patient characteristics also significantly affect CHF outcomes. Kossovsky et al. found that as age increased, the probability of hospitalization increased, whereas another study showed that older age was associated with decreased costs in heart failure patients. Patient factors like nature of insurance coverage affect the type and intensity of health care provided. Those, in turn, affect short-term as well as long-term outcomes. Studies have shown that managed care (MC) affects outcomes in CHF due to shorter length-of-stay (LOS) and increased emergency room use, potentially resulting in poor quality of health care. Other studies have shown that patient characteristics such as gender, race, insurance coverage, and disease severity also affect CHF-related outcomes.
The aforementioned studies were conducted in specific hospital settings, in specific patient populations, and in certain geographic areas. Results from these studies generally reflect systems of care in those settings, and their generalizability can be questioned. A multistate estimate across all hospitals, adjusted for specific characteristics, may help validate some of the above findings. The Healthcare Cost and Utilization Project (HCUP) dataset, a nationally representative hospital dataset, provided a unique opportunity to examine differences in CHF-related outcomes such as hospital charges, LOS, and mortality by patient as well as by hospital characteristics. The aim of this study was to examine various hospital- as well as patient-related factors that may account for differences in CHF-related outcomes.
The aim of this study was to demonstrate differences in hospitalization outcomes including length-of-stay (LOS), charges, and mortality in congestive heart failure patients using the Healthcare Cost and Utilization Project dataset. Hospitalizations with International Classification of Diseases, Ninth Revision, clinical modification (ICD-9-CM) codes for congestive heart failure were extracted from a 10% random Healthcare Cost and Utilization Project sample to yield 19,693 hospitalizations between January 1 and December 31, 1997. Mean hospital charges were $11,688 and mean LOS was 5.83 days. The overall in-hos-pital mortality rate was 4.7%. Both LOS and hospital charges were higher in urban compared with rural hospitals (p ≤ 0.05). LOS and charges also increased with hospital size (p ≤ 0.05). Among patient characteristics, patient health status significantly affected LOS, charges, and mortality. Privately insured/health maintenance organization patients had 9% shorter LOS than Medicare patients, and Medicaid patients had 6.6% lower charges and 42% lower mortality than Medicare patients (p ≤ 0.05). Other significant predictors of study outcome variables included age, gender, race, hospital region, and hospital experience.
Congestive heart failure (CHF) has become a major public health concern in the United States as a result of increasing prevalence and resource use coupled with technology advances. Due to its age-dependent nature, CHF is the most commonly listed diagnosis in hospitalizations of elderly persons. The estimated annual inpatient costs for CHF exceed $8 billion, annual out-of-pocket expenditures exceed $3 billion, and overall management of heart failure costs $18 billion per year. As baby boomers age and live longer, the prevalence of CHF will increase and consequently increase the financial burden on patients, families, health care systems, and society.
CHF is characterized by increasing hospitalization rates and decreasing survival rates. To address issues of quality and cost of care provided, understanding hospital-related factors that affect CHF outcomes becomes important because hospitalizations represent a major percentage of overall CHF disease cost burden. Hospital characteristics such as for-profit status and teaching/nonteaching status have been shown to affect quality of care and outcomes. Rural community hospitals have been shown to under-prescribe β-blockers and angiotensin-converting enzyme inhibitors in heart failure patients. Hospital size (based on number of beds) has also been shown to influence CHF outcomes. A study by Taylor et al. showed that Medicare payments for CHF patients were higher for patients admitted to for-profit hospitals. The study also showed that teaching hospitals had lower mortality rates compared with for-profit hospitals. The amount of experience in treating heart failure patients (patient volume) has also been shown to affect CHF-related hospitalization outcomes.
Studies have shown that patient characteristics also significantly affect CHF outcomes. Kossovsky et al. found that as age increased, the probability of hospitalization increased, whereas another study showed that older age was associated with decreased costs in heart failure patients. Patient factors like nature of insurance coverage affect the type and intensity of health care provided. Those, in turn, affect short-term as well as long-term outcomes. Studies have shown that managed care (MC) affects outcomes in CHF due to shorter length-of-stay (LOS) and increased emergency room use, potentially resulting in poor quality of health care. Other studies have shown that patient characteristics such as gender, race, insurance coverage, and disease severity also affect CHF-related outcomes.
The aforementioned studies were conducted in specific hospital settings, in specific patient populations, and in certain geographic areas. Results from these studies generally reflect systems of care in those settings, and their generalizability can be questioned. A multistate estimate across all hospitals, adjusted for specific characteristics, may help validate some of the above findings. The Healthcare Cost and Utilization Project (HCUP) dataset, a nationally representative hospital dataset, provided a unique opportunity to examine differences in CHF-related outcomes such as hospital charges, LOS, and mortality by patient as well as by hospital characteristics. The aim of this study was to examine various hospital- as well as patient-related factors that may account for differences in CHF-related outcomes.
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