National trends in hospital length of stay for acute myocardial infarction in China

BMC Cardiovascular Disorders

Lixin Jiang⁵  Harlan M Krumholz³  Frank B Hu¹  John A Spertus²  Qing Wang⁵  Lingling Li⁷  Sudhakar V Nuti³  Sonia Hernández-Díaz⁸  Xi Li⁵  Jing Li⁵  Frederick A Masoudi⁶  Zhenqiu Lin³  Qian Li⁴ 

[1] Department of Nutrition, Harvard School of Public Health, Boston, MA, USA;Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA;Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT, USA;Epidemiology, Worldwide Safety & Regulatory, Pfizer Inc., New York, NY, USA;National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China;Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA;Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA;Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

关键词: Variation in care;    Length of stay;    Acute myocardial infarction;   

Others  :  1103127
DOI  :  10.1186/1471-2261-15-9

 received in 2014-07-27, accepted in 2015-01-12,  发布年份 2015

【 摘 要 】

Background

China is experiencing increasing burden of acute myocardial infarction (AMI) in the face of limited medical resources. Hospital length of stay (LOS) is an important indicator of resource utilization.

Methods

We used data from the Retrospective AMI Study within the China Patient-centered Evaluative Assessment of Cardiac Events, a nationally representative sample of patients hospitalized for AMI during 2001, 2006, and 2011. Hospital-level variation in risk-standardized LOS (RS-LOS) for AMI, accounting for differences in case mix and year, was examined with two-level generalized linear mixed models. A generalized estimating equation model was used to evaluate hospital characteristics associated with LOS. Absolute differences in RS-LOS and 95% confidence intervals were reported.

Results

The weighted median and mean LOS were 13 and 14.6 days, respectively, in 2001 (n = 1,901), 11 and 12.6 days in 2006 (n = 3,553), and 11 and 11.9 days in 2011 (n = 7,252). There was substantial hospital level variation in RS-LOS across the 160 hospitals, ranging from 9.2 to 18.1 days. Hospitals in the Central regions had on average 1.6 days (p = 0.02) shorter RS-LOS than those in the Eastern regions. All other hospital characteristics relating to capacity for AMI treatment were not associated with LOS.

Conclusions

Despite a marked decline over the past decade, the mean LOS for AMI in China in 2011 remained long compared with international standards. Inter-hospital variation is substantial even after adjusting for case mix. Further improvement of AMI care in Chinese hospitals is critical to further shorten LOS and reduce unnecessary hospital variation.

【 授权许可】

   
2015 Li et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

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Figure 3.

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