Abstract 3275: Does Hospital Length of Stay for Heart Failure Influence Compliance with Performance Measures? An Analysis of Get With The Guidelines - Heart Failure
Introduction: Quality of Care (QOC) during admission for heart failure (HF) may significantly impact readmissions and mortality. The relationship between QOC and length of stay (LOS) in patients hospitalized with acute HF has not been well studied.
Objective: To evaluate whether LOS in patients hospitalized with acute HF effects QOC, as indexed by performance and quality measures.
Methods: Get With The Guidelines (GWTG) employs a collaborative model of care and a web-based Patient Management ToolTM (Outcome, Cambridge, MA) for data collection, decision support, on-demand reporting, and patient education. Baseline data for HF patients who survived to discharge was recorded for 36,078 admissions at 209 sites from 1/05 – 9/06. The cohort was stratified by median HF hospitalization LOS (5 days): LOS < median (n = 15,515) and LOS ≤ median (n = 20,563). Patient history, labs, performance and quality measures were compared between the two groups. Generalized estimating equation method adjusted for age, gender, race, payment source, medical history, body mass index, heart rate, blood pressure, blood urea nitrogen, creatinine, left ventricular ejection fraction (LVEF), and hospital clustering.
Results: Patients with LOS ≤ 5 days were slightly older, more likely to be at a larger hospital, had higher LVEF, and increased rates of certain comorbidities such as diabetes, anemia, renal insufficiency, and pulmonary disease. LOS ≤ 5 days was associated with higher odds of receiving discharge instructions and LVEF documentation, similar treatment with beta-blockers, but lower likelihood of receiving angiotensin converting enzyme inhibitor or angiotensin receptor blocker at discharge. Composite performance measures were higher in those with LOS ≤ 5 days (Table⇓).
Conclusions: Shorter LOS for HF is associated with decreased conformity in some but not other QOC measures. Further efforts are needed to improve the timely delivery of quality care during hospitalization for HF.