Abstract 13642: Hospitalist Care and Associated Outcomes for Patients Hospitalized with Heart Failure: Insights from Get With The Guidelines-Heart Failure
Background: The use of hospitalists to care for general medical admissions has increased nationally, but the role of hospitalists and associated patient outcomes among heart failure (HF) admissions are poorly described.
Methods: We analyzed data from hospitals participating in the GWTG-HF registry from 2005-2008 linked to Medicare claims. The exposure of interest was the hospital's rate of use of hospitalists as attendings for HF stays, determined annually using Medicare claims data. We examined outcomes for patients stratified by hospital type - academic teaching hospitals, non-academic tertiary hospitals (non-teaching with cardiology services), and small community hospitals (non-teaching without cardiology services). Using multivariable models, we estimated the relationship between hospital-level use of hospitalists and patient-level risk-adjusted outcomes - 30-day readmission, 30-day mortality, and length of stay (LOS).
Results: Our analysis included 31,504 Medicare beneficiaries in 166 hospitals. Median rates of hospitalist attending were 16.5% (IQR 6.5%, 31.7%), 13.3% (2.9%, 29.0%), and 17.4% (0.0%, 33.8%) in teaching, tertiary, and community hospitals, respectively. After multivariable adjustment, overall rate of hospitalist attending was associated with modestly lower risk of 30-day readmission and LOS, but was not associated with 30-day mortality. Among hospital types, the association between hospitalist and 30-day readmissions rates and LOS was only significant in non-academic tertiary hospitals. Among community hospitals, rates of hospitalist attending was associated with a higher 30-day mortality risk (Table).
Conclusion: Hospitalists attended for 1 in 6 Medicare beneficiaries hospitalized with HF. Hospitalist care was associated with modestly lower readmission rates and hospital length of stay, particularly at non-academic tertiary hospitals.
- © 2011 by American Heart Association, Inc.