ArticleCirculation. Cardiovascular quality and outcomes2009
Looking forward, looking back: assessing variations in hospital resource use and outcomes for elderly patients with heart failure.
Article in Circulation. Cardiovascular quality and outcomes, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
40 citing papers in PubMed, 2 syntheses or guidelines pooled it, 123 citations in OpenAlex.
- A Systematic Review of the Association Between Hospital Cost/price and the Quality of Care.Applied health economics and health policy · 2020Pooled it
- The association between health care quality and cost: a systematic review.Annals of internal medicine · 2013Pooled it
- Effectiveness of Remote Patient Monitoring After Discharge of Hospitalized Patients With Heart Failure: The Better Effectiveness After Transition -- Heart Failure (BEAT-HF) Randomized Clinical Trial.JAMA internal medicine · 2016Trial
- Trial
- End-of-life cohorts from the Dartmouth Institute: risk adjustment across health care markets, the relative efficiency of chronic illness utilization, and patient experiences near the end of life.Research in health services & regions · 2024Review
- Burden of hospitalizations in newly diagnosed heart failure patients in Poland: real world population based study in years 2013-2019.ESC heart failure · 2022Article
- Is mortality readmissions bias a concern for readmission rates under the Hospital Readmissions Reduction Program?Health services research · 2020Article
- Association of Thyroid Function with Early/Mid-term Aorta-Related Adverse Events and Readmissions after Thoracic Endovascular Aortic Repair.Scientific reports · 2017Article
- Association between costs and quality of acute myocardial infarction care hospitals under the Korea National Health Insurance program.Medicine · 2017Article
- Trends in health care expenditure among US adults with heart failure: The Medical Expenditure Panel Survey 2002-2011.American heart journal · 2017Article
- Regional disparities in hospitalization charges for patients undergoing craniotomy for tumor resection in New York State: correlation with outcomes.Journal of neuro-oncology · 2016Article
- The Role of Geography in the Assessment of Quality: Evidence from the Medicare Advantage Program.PloS one · 2016Article
- Quality-Cost Relationship in Congenital Heart Surgery.The Annals of thoracic surgery · 2015Article
- Long-term impact of medicare payment reductions on patient outcomes.Health services research · 2014Article
- A population health approach to reducing observational intensity bias in health risk adjustment: cross sectional analysis of insurance claims.BMJ (Clinical research ed.) · 2014Article
- Hospital costs and inpatient mortality among children undergoing surgery for congenital heart disease.Health services research · 2014Article
- Impact of critical care medicine training programs' palliative care education and bedside tools on ICU use at the end of life.Journal of graduate medical education · 2014Article
- Predictors and impact of thirty-day readmission on patient outcomes and health care costs after reduced-toxicity conditioning allogeneic hematopoietic cell transplantation.Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation · 2014Article
- The association of unfavorable outcomes with the intensity of neurosurgical care in the United States.PloS one · 2014Article
- Are readmission rates on a neurosurgical service indicators of quality of care?Journal of neurosurgery · 2013Article
Corrections and comments
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Authors and funding
13 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundRecent studies have found substantial variation in hospital resource use by expired Medicare beneficiaries with chronic illnesses. By analyzing only expired patients, these studies cannot identify differences across hospitals in health outcomes like mortality. This study examines the association between mortality and resource use at the hospital level, when all Medicare beneficiaries hospitalized for heart failure are examined. METHODS AND
resultsA total of 3999 individuals hospitalized with a principal diagnosis of heart failure at 6 California teaching hospitals between January 1, 2001, and June 30, 2005, were analyzed with multivariate risk-adjustment models for total hospital days, total hospital direct costs, and mortality within 180-days after initial admission ("Looking Forward"). A subset of 1639 individuals who died during the study period were analyzed with multivariate risk-adjustment models for total hospital days and total hospital direct costs within 180-days before death ("Looking Back"). "Looking Forward" risk-adjusted hospital means ranged from 17.0% to 26.0% for mortality, 7.8 to 14.9 days for total hospital days, and 0.66 to 1.30 times the mean value for indexed total direct costs. Spearman rank correlation coefficients were -0.68 between mortality and hospital days, and -0.93 between mortality and indexed total direct costs. "Looking Back" risk-adjusted hospital means ranged from 9.1 to 21.7 days for total hospital days and 0.91 to 1.79 times the mean value for indexed total direct costs. Variation in resource use site ranks between expired and all individuals were attributable to insignificant differences.
conclusionsCalifornia teaching hospitals that used more resources caring for patients hospitalized for heart failure had lower mortality rates. Focusing only on expired individuals may overlook mortality variation as well as associations between greater resource use and lower mortality. Reporting values without identifying significant differences may result in incorrect assumption of true differences.
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