Hospital Stays Shorter for Heart Failure
Study Shows Hospital Readmissions and Admissions to Nursing Homes Are Up
June 1, 2010 -- The average hospital stay for heart failure has declined from almost nine days to just over six days in a little over a decade, but there is new evidence patients may be being sent home too soon.
The current Medicare fee-for-service system rewards hospitals for discharging patients sooner, rather than later, but the impact of shorter hospitalizations on patient outcomes has not been fully understood.
An analysis of close to 7 million heart failure hospitalizations among Medicare recipients found that the average time in the hospital declined by almost three days between 1993 and 2006.
Death rates during initial hospitalization also dropped, but deaths after discharge increased, as did hospital readmissions within 30 days of discharge and discharges to nursing facilities instead of home.
The study is published in the June 2 issue of The Journal of the American Medical Association.
Study co-author Harlan M. Krumholz, MD, of Yale University, says the findings suggest that many patients are discharged before they are ready without the medical support they need to transition from hospital to home.
"This system has worked well for everyone but the patient and society," he tells WebMD. "The hospitals made more money with shorter initial stays and readmissions, and nursing facilities have more patients."
Heart Failure Hospitalization Trends
Krumholz credits advances in the treatment of heart failure over the 14-year period studied for the drop in deaths during initial hospitalization.
Between 1993 and 2006, the in-hospital death rate declined by almost 50%, from 8.5% to 4.3%.
But during the same period, deaths in the 30 days following hospital discharge increased from around 4% to 6%.
Among the other findings:
- One in 3 patients was discharged to other health care facilities instead of home in 2006, compared to one in four in 1993.
- There was a 53% increase in discharges to skilled nursing facilities, from 13% to 20%.
- Hospital readmissions within 30 days of discharge increased by 20%, from 17% to 20% during the 14-year period.
"Most people would not consider it progress to get out of the hospital sooner when that is coupled with a 20% increase in readmissions and a 53% increase in nursing home admissions," Krumholz says.