Monday, November 5, 2007

This presentation is part of : Outcomes of Care Strategies
Health Disparities in Length of Stay and Total Cost of Care for Heart Failure Discharges
Jennifer J. Hatzfeld, MEd, MSN, RN-BC1, Stuart Russell, MD2, JoAnn Z. Ioannou, RN, MSN, MBA3, Edward K. Kasper, MD, FACC4, Karen K. Davis, MSN, RN3, Peter Pronovost, MD, PhD5, and Cheryl R. Dennison, RN, ANP, PhD1. (1) School of Nursing, Johns Hopkins University, Baltimore, MD, USA, (2) Johns Hopkins Hospital, Baltimore, MD, USA, (3) Department of Medical Nursing, Johns Hopkins Hospital, Baltimore, MD, USA, (4) Johns Hopkins Bayview Medical Center, Baltimore, MD, USA, (5) Center for Innovation in Quality Patient Care, Johns Hopkins University, Baltimore, MD, USA
Learning Objective #1: recognize identified differences in outcomes of care for heart failure discharges by race, gender, and age.
Learning Objective #2: identify potential sources of disparity in outcomes of care for heart failure patients.

Background: Management of heart failure (HF) in the acute care setting is complex and challenging. The direct and indirect cost of HF in 2006 was estimated at 29.6 billion dollars. African Americans, women, and elderly are disproportionately affected by heart failure.

Purpose: Outcomes of HF were compared, including length of stay (LOS), 30 day readmission status, total admission cost, and in-hospital mortality by gender, race, and age.

Methods: In this descriptive, comparative study, medical record data for hospital discharges between October 1, 2004 and September 30, 2006 from 2 urban academic medical centers was examined. Discharges were included if primary diagnosis was HF and excluded if < 21 years of age or LOS exceeded 30 days.  T-tests and ANOVA were used for comparisons.

Results: Over 2 years, there were 3211 HF discharges. Of these, 52% had a HF admitting diagnosis; 50% were female; 46% African American. Mean age was 65±15 years, LOS 5.0±4.6 days, total admission cost $16,552±21,662. Rate for 30-day readmission status was 20% and in-hospital mortality, 1.8%. As shown in the summary data, below, significant differences were noted in LOS by gender (p<0.01) and age (p<0.05). Total admission cost differed significantly by gender (p<0.01), age (p<0.01), and race (p<.01). There were no significant group differences in HF admitting diagnosis, in-hospital mortality rate, or 30-day readmission status.

                                                Cost ($),                   LOS (days),
                                                mean±SD                mean±SD
       Male                                  19,355±25,830         5.38±4.95
       Female                             13,705±15,887         4.66±4.09
      Caucasian                        17,580±23,885         5.09±4.69*
      African American            14,951±18,381         4.93±4.34*
          *results not significant (p=0.587)
  Age, in years
      21-39                                  20,258±25,186         5.60±5.10
      40-59                                  17,106±24,983         4.87±4.47
      60-79                                  17,762±21,698         5.18±4.82
      >80                                     11,949±11,907         4.75±3.85

Conclusions: Disparities in HF LOS and total cost of admission were identified. Further research is required to explore factors that may contribute to these disparities as well as the impact of these inequalities in acute care on overall HF disease management.