THE RELATIONSHIP BETWEEN HOSPITAL LENGTH OF STAY AND RATE OF DEATH INHEART-FAILURE

OBJECTIVE: To study the relationship between length of stay (LOS) and the rate of death among patients hospitalized with congestive heart fa ilure (CHF). DESIGN: A retrospective, observational study, SETTING: Fi fteen acute care community hospitals in upstate New York. PATIENTS: Th ree thousand nine hundred fourteen patients whose principal billing di agnosis was diagnosis-related, group number 127 (CHF and shock). OUTCO ME MEASURES: Mean total LOS and hospital death rare. VARIABLES: Mean n umber of nonacute care hospital days per patient, mean number of acute care days (acute LOS) per patient, cases per hospital, hospital bed c apacity, and the presence of a cardiac catheterization laboratory card iac surgical services. or a medical residency training program. An ind ex of severity of illness and a severity-weighted expected LOS were ca lculated for each patient as well. RESULTS: Significant variability in mean total LOS (7.6 to 12.7 days), mean acute LOS (7.1 to 10.3 days), and death rates (4.3 to 12.0%) was noted among the centers. Minimal v ariation in mean expected LOS (5.2 to 6.1 days) and mean severity scor e (2.8 to 3.3) was observed. Mean total LOS (r = 0.14, p = 0.61) and a cute LOS (r = 0.11, p = 0.69) were not related significantly to death rate for the 15 centers. When the hospitals were separated into tertil es based on rank order of total LOS and acute LOS, no differences amon g the subgroups were noted in the number of cases per hospital, deaths per hospital, death rates, expected LOS, and severity scores. Interho spital variation in total LOS was partially explained by the care of p atients who did not require acute hospitalization. CONCLUSIONS: Signif icant interhospital variation exists in LOS and death rates for patien ts admitted with CHF; these two measures are not related to each anoth er,This variability in outcome cannot be explained by severity of illn ess case-mix alone; significant variation in the processes and effecti veness of patient care may exist.