Philbin E F, Roerden J B
Cardiovascular Division, Henry Ford Hospital, Detroit, MI 48202-2689, USA.
Am J Manag Care. 1997 Sep;3(9):1285-91.
Efforts to reduce hospital lengths of stay (LOS) are prevalent, despite limited understanding of the clinical impact of duration of hospitalization. Thus, we sought to evaluate the clinical relevance of LOS in congestive heart failure (CHF) by studying its relationship to inpatient and post-discharge outcomes among individuals with this disorder. Ten acute care community hospitals in New York State participated in this investigation. The study population consisted of 1,402 consecutive patients, predominantly elderly, who were hospitalized for evaluation and treatment of moderately severe or severe CHF. The patients' medical records were abstracted by trained personnel immediately after hospital discharge. Patients were followed forward for six month's time to track death and readmission rates, as well as functional status, quality of life, and satisfaction. Mean LOS for the group was 7.9 +/- 9.2 days. Longer LOS had a neutral or negative association with patient outcomes. Specifically, longer LOS was linked to a higher adjusted mortality rate during the index hospitalization, as well as a greater adjusted risk of death during the post-discharge period. Moreover, longer LOS was associated with worse post-discharge functional class and a trend for less patient satisfaction with their physicians' care. We conclude that death becomes more prevalent and functional measures decline in association with prolonged hospital stays for heart failure. Although these findings may be of use in planning management strategies, they offer no proof that reducing the costs of care will improve clinical outcomes in CHF.
尽管对住院时长的临床影响了解有限，但缩短医院住院时长的努力仍很普遍。因此，我们试图通过研究住院时长与充血性心力衰竭（CHF）患者住院期间及出院后结局之间的关系，来评估住院时长在CHF中的临床相关性。纽约州的十家急性护理社区医院参与了这项调查。研究人群包括1402例连续入院的患者，主要为老年人，因中度或重度CHF的评估和治疗而住院。患者出院后，经过培训的人员立即提取其病历。对患者进行为期六个月的随访，以跟踪死亡率和再入院率，以及功能状态、生活质量和满意度。该组的平均住院时长为7.9±9.2天。较长的住院时长与患者结局呈中性或负相关。具体而言，较长的住院时长与首次住院期间调整后的较高死亡率以及出院后期间调整后的较高死亡风险相关。此外，较长的住院时长与出院后较差的功能分级相关，并且患者对医生护理的满意度有降低趋势。我们得出结论，随着心力衰竭患者住院时间延长，死亡更为普遍，功能指标下降。尽管这些发现可能有助于规划管理策略，但它们并不能证明降低护理成本会改善CHF的临床结局。
