PURPOSE:Despite major advances in the management, heart failure (HF) remains a substantial cause of hospitalization. Evidence-based clinical practice guidelines have been developed and components of these guidelines have been adapted by Joint Commission (JC) to create core performance measures for patients hospitalized with HF. However, little is known regarding the application of these core measures, or if variation in adherence to these core measures impacts the length of stay (LOS) in patients with HF. The objective of the present study is to compare overall adherence and variability in application of the four JC HF core performance measures between teaching and non teaching hospitals in the state of California. Comparison was also made on the average length of stay between teaching and non teaching hospitals in relation to their respective JC HF core measures.
METHODS:2006 data on all hospitals providing HF care in the state of California was evaluated. There were 328 participating hospitals. The teaching status of each institution was determined using information from the Accreditation Council for Graduate Medical Education.
RESULTS:Teaching hospitals accounted for 28.2% of the participating institutions. Application of the four JC HF core measures, expressed in percent of patient population, and mean length of stay, expressed in days, for both groups are listed in Table 1. Teaching hospitals have a higher core measure performance score in ACEI/ARB therapy (89.5% vs. 85.4%, p=<0.01), assessment of ejection fraction (94.5% vs. 88.5%, p=<0.01))and length of stay (4.49 days vs. 5.12 days, p=<0.01). Smoking cessation counseling (88.5% vs. 90.1%, p=ns) and discharge instructions (66% vs 66.8%, p=ns)are similar in both groups.
CONCLUSION:Results of this study suggest that teaching hospitals in California are more compliant with the use ACEI/ARB therapy, assessment of left ventricular function and have a significantly lower length of stay compared to non teaching hospitals. There was no significant difference in the utilization of discharge education or smoking cessation counseling between hospital types.
CLINICAL IMPLICATIONS:Hospitals with teaching affiliation have higher core performance measure.
DISCLOSURE:Raymond Yau, No Financial Disclosure Information; No Product/Research Disclosure Information