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Relationship between Hospital 30-Day Mortality Rates for Heart Failure and Patterns of Early Inpatient Comfort Care.

Publication ,  Journal Article
Chen, LM; Levine, DA; Hayward, R; Cox, M; Schulte, PJ; DeVore, AD; Hernandez, A; Heidenreich, PA; Yancy, C; Fonarow, GC
Published in: J Hosp Med
March 2018

BACKGROUND: The Centers for Medicare & Medicaid Services rewards hospitals that have low 30-day riskstandardized mortality rates (RSMR) for heart failure (HF). OBJECTIVE: To describe the use of early comfort care for patients with HF, and whether hospitals that more commonly initiate comfort care have higher 30-day mortality rates. DESIGN: A retrospective, observational study. SETTING: Acute care hospitals in the United States. PATIENTS: A total of 93,920 fee-for-service Medicare beneficiaries admitted with HF from January 2008 to December 2014 to 272 hospitals participating in the Get With The Guidelines-Heart Failure registry. EXPOSURE: Early comfort care (defined as comfort care within 48 hours of hospitalization) rate. MEASUREMENTS: A 30-day RSMR. RESULTS: Hospitals' early comfort care rates were low for patients admitted for HF, with no change over time (2.5% to 2.6%, from 2008 to 2014, P = .56). Rates varied widely (0% to 40%), with 14.3% of hospitals not initiating comfort care for any patients during the first 2 days of hospitalization. Risk-standardized early comfort care rates were not correlated with RSMR (median RSMR = 10.9%, 25th to 75th percentile = 10.1% to 12.0%; Spearman's rank correlation = 0.13; P = .66). CONCLUSIONS: Hospital use of early comfort care for HF varies, has not increased over time, and on average, is not correlated with 30-day RSMR. This suggests that current efforts to lower mortality rates have not had unintended consequences for hospitals that institute early comfort care more commonly than their peers.

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Published In

J Hosp Med

DOI

EISSN

1553-5606

Publication Date

March 2018

Volume

13

Issue

3

Start / End Page

170 / 176

Location

United States

Related Subject Headings

  • United States
  • Socioeconomic Factors
  • Sex Factors
  • Risk Factors
  • Retrospective Studies
  • Racial Groups
  • Patient Comfort
  • Medicare
  • Male
  • Insurance Claim Review
 

Citation

APA
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ICMJE
MLA
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Chen, L. M., Levine, D. A., Hayward, R., Cox, M., Schulte, P. J., DeVore, A. D., … Fonarow, G. C. (2018). Relationship between Hospital 30-Day Mortality Rates for Heart Failure and Patterns of Early Inpatient Comfort Care. J Hosp Med, 13(3), 170–176. https://doi.org/10.12788/jhm.2862
Chen, Lena M., Deborah A. Levine, Rodney Hayward, Margueritte Cox, Phillip J. Schulte, Adam D. DeVore, Adrian Hernandez, Paul A. Heidenreich, Clyde Yancy, and Gregg C. Fonarow. “Relationship between Hospital 30-Day Mortality Rates for Heart Failure and Patterns of Early Inpatient Comfort Care.J Hosp Med 13, no. 3 (March 2018): 170–76. https://doi.org/10.12788/jhm.2862.
Chen LM, Levine DA, Hayward R, Cox M, Schulte PJ, DeVore AD, et al. Relationship between Hospital 30-Day Mortality Rates for Heart Failure and Patterns of Early Inpatient Comfort Care. J Hosp Med. 2018 Mar;13(3):170–6.
Chen, Lena M., et al. “Relationship between Hospital 30-Day Mortality Rates for Heart Failure and Patterns of Early Inpatient Comfort Care.J Hosp Med, vol. 13, no. 3, Mar. 2018, pp. 170–76. Pubmed, doi:10.12788/jhm.2862.
Chen LM, Levine DA, Hayward R, Cox M, Schulte PJ, DeVore AD, Hernandez A, Heidenreich PA, Yancy C, Fonarow GC. Relationship between Hospital 30-Day Mortality Rates for Heart Failure and Patterns of Early Inpatient Comfort Care. J Hosp Med. 2018 Mar;13(3):170–176.
Journal cover image

Published In

J Hosp Med

DOI

EISSN

1553-5606

Publication Date

March 2018

Volume

13

Issue

3

Start / End Page

170 / 176

Location

United States

Related Subject Headings

  • United States
  • Socioeconomic Factors
  • Sex Factors
  • Risk Factors
  • Retrospective Studies
  • Racial Groups
  • Patient Comfort
  • Medicare
  • Male
  • Insurance Claim Review