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Resource utilization in patients hospitalized with heart failure: insights from a contemporary national hospital database.
Am Heart J. 2008 Jun; 155(6):978-985.e1.AH

Abstract

BACKGROUND

Heterogeneity of disease severity and clinical trajectory has been described among patients hospitalized with heart failure (HF). However, little is known about the variability in and contributors to costs associated with HF hospitalizations. We examined the distribution of costs associated with a HF diagnosis in a large contemporary hospital database.

METHODS

Diagnosis and procedure codes were systematically used to identify primary inpatient HF admissions to hospitals participating in the PREMIER database 2004-2005. Average costs per day and division of costs among hospital departments were evaluated based on patient and hospitalization characteristics.

RESULTS

Total number of hospitalizations was 278,214; 36% had a length of stay (LOS) >5 days. There was a clear association between type of intravenous therapy, LOS, inhospital mortality, and cost. For example, patients initiated on a single intravenous inotrope had a longer mean LOS (9.6 days), greater inhospital mortality rate (14.7%), and higher mean total cost ($18,411) than any other medical therapy administered during hospitalization. The single largest contributor to cost was room and board. Forty-six percent of hospitalizations with diagnosis-related group code 127 (n = 234,204) exceeded average Medicare reimbursement. Variables on admission associated with highest cost hospitalizations were age <75 years, non-black race, male sex, and urban teaching hospital status.

CONCLUSIONS

Length of stay is the determinant of cost for HF hospitalizations. Use of vasoactive therapy is a marker for longer LOS, higher mortality, and greater costs. Improved reimbursement rates or improved therapeutic options that lessen LOS are required if the costs of HF care are to be minimized.

Authors+Show Affiliations

Division of Cardiology, Department of Medicine, Saint Louis University School of Medicine, St Louis, MO 63110, USA. hauptmpj@slu.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18513507

Citation

Hauptman, Paul J., et al. "Resource Utilization in Patients Hospitalized With Heart Failure: Insights From a Contemporary National Hospital Database." American Heart Journal, vol. 155, no. 6, 2008, pp. 978-985.e1.
Hauptman PJ, Swindle J, Burroughs TE, et al. Resource utilization in patients hospitalized with heart failure: insights from a contemporary national hospital database. Am Heart J. 2008;155(6):978-985.e1.
Hauptman, P. J., Swindle, J., Burroughs, T. E., & Schnitzler, M. A. (2008). Resource utilization in patients hospitalized with heart failure: insights from a contemporary national hospital database. American Heart Journal, 155(6), 978-e1. https://doi.org/10.1016/j.ahj.2008.01.015
Hauptman PJ, et al. Resource Utilization in Patients Hospitalized With Heart Failure: Insights From a Contemporary National Hospital Database. Am Heart J. 2008;155(6):978-985.e1. PubMed PMID: 18513507.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Resource utilization in patients hospitalized with heart failure: insights from a contemporary national hospital database. AU - Hauptman,Paul J, AU - Swindle,Jason, AU - Burroughs,Thomas E, AU - Schnitzler,Mark A, Y1 - 2008/03/14/ PY - 2007/11/02/received PY - 2008/01/22/accepted PY - 2008/6/3/pubmed PY - 2008/6/20/medline PY - 2008/6/3/entrez SP - 978 EP - 985.e1 JF - American heart journal JO - Am. Heart J. VL - 155 IS - 6 N2 - BACKGROUND: Heterogeneity of disease severity and clinical trajectory has been described among patients hospitalized with heart failure (HF). However, little is known about the variability in and contributors to costs associated with HF hospitalizations. We examined the distribution of costs associated with a HF diagnosis in a large contemporary hospital database. METHODS: Diagnosis and procedure codes were systematically used to identify primary inpatient HF admissions to hospitals participating in the PREMIER database 2004-2005. Average costs per day and division of costs among hospital departments were evaluated based on patient and hospitalization characteristics. RESULTS: Total number of hospitalizations was 278,214; 36% had a length of stay (LOS) >5 days. There was a clear association between type of intravenous therapy, LOS, inhospital mortality, and cost. For example, patients initiated on a single intravenous inotrope had a longer mean LOS (9.6 days), greater inhospital mortality rate (14.7%), and higher mean total cost ($18,411) than any other medical therapy administered during hospitalization. The single largest contributor to cost was room and board. Forty-six percent of hospitalizations with diagnosis-related group code 127 (n = 234,204) exceeded average Medicare reimbursement. Variables on admission associated with highest cost hospitalizations were age <75 years, non-black race, male sex, and urban teaching hospital status. CONCLUSIONS: Length of stay is the determinant of cost for HF hospitalizations. Use of vasoactive therapy is a marker for longer LOS, higher mortality, and greater costs. Improved reimbursement rates or improved therapeutic options that lessen LOS are required if the costs of HF care are to be minimized. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/18513507/Resource_utilization_in_patients_hospitalized_with_heart_failure:_insights_from_a_contemporary_national_hospital_database_ DB - PRIME DP - Unbound Medicine ER -