Predictors and determinants of hospital length of stay in congestive heart failure in ten community hospitals.

BACKGROUND: Little is known about the actual determinants of hospital length of stay (LOS) among patients admitted with congestive heart failure (CHF), in spite of its economic impact. To increase understanding of these factors, we examined the demographic, clinical, laboratory, and treatment characteristics of patients hospitalized with decompensated CHF. METHODS: The charts of consecutive patients admitted to 10 acute care community hospitals during 1995 were reviewed. The relationship between LOS and more than 140 patient-specific variables were examined. First, patient characteristics identifiable within the first 24 hours of hospitalization were examined for their relationship with LOS. Then, variables indicative of the processes of care and response to treatment were studied. Finally, administrative data were added to yield the final model for LOS. RESULTS: During the study period 1402 patients were admitted to the participating centers. The patients were predominantly elderly with moderately severe or severe CHF. With stepwise multiple linear regression, 5% of the variation in LOS could be explained by baseline characteristics alone (r = 0.22, p < 0.0001). When treatment and response variables were added to this model, 15% of the variation in LOS could be explained (r = 0.39, p < 0.0001). When administrative data were added, the final model explained 31% of the variation in LOS (r = 0.56, p < 0.0001). CONCLUSIONS: We conclude that LOS among patients hospitalized with decompensated CHF is partially related to patient demographics, severity of illness, management modalities, response to treatment, and administrative data. However, significant residual variation in LOS exists, which cannot be explained by these factors. These observations may be of value in the design and implementation of initiatives aimed at reducing resource utilization and improving quality of care in CHF.

The relationship between hospital length of stay and rate of death in heart failure.

OBJECTIVE: To study the relationship between length of stay (LOS) and the rate of death among patients hospitalized with congestive heart failure (CHF). DESIGN: A retrospective, observational study. SETTING: Fifteen acute care community hospitals in upstate New York. PATIENTS: Three thousand nine hundred fourteen patients whose principal billing diagnosis was diagnosis-related group number 127 (CHF and shock). OUTCOME MEASURES: Mean total LOS and hospital death rate. VARIABLES: Mean number of nonacute care hospital days per patient, mean number of acute care days (acute LOS) per patient, cases per hospital, hospital bed capacity, and the presence of a cardiac catheterization laboratory, cardiac surgical services, or a medical residency training program. An index of severity of illness and a severity-weighted expected LOS were calculated 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 variation in mean expected LOS (5.2 to 6.1 days) and mean severity score (2.8 to 3.3) was observed. Mean total LOS (r = 0.14, p = 0.61) and acute LOS (r = 0.11, p = 0.69) were not related significantly to death rate for the 15 centers. When the hospitals were separated into tertiles based on rank order of total LOS and acute LOS, no differences among the subgroups were noted in the number of cases per hospital, deaths per hospital, death rates, expected LOS, and severity scores, Interhospital variation in total LOS was partially explained by the care of patients who did not require acute hospitalization. CONCLUSIONS: Significant interhospital variation exists in LOS and death rates for patients admitted with CHF; these two measures are not related to each another. This variability in outcome cannot be explained by severity of illness case-mix alone; significant variation in the processes and effectiveness of patient care may exist.

A rapid procedure for screening and isolating oxygenated free fatty acid metabolites from plants and natural waters.

A rapid method of isolating a relatively pure fraction of oxygenated fatty acids from plants and natural waters is described. These metabolites were isolated from aqueous extracts using octadecylsilyl silica in a reverse-phase batch extraction method. The extraction method, together with reverse-phase analytical high pressure liquid chromatography (HPLC), was used to establish a routine screening method for the presence of these compounds in a variety of natural sources. A reverse-phase preparative HPLC purification method is also described.