Dataset Information

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

ABSTRACT: 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.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.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.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.

SUBMITTER: Li Q

PROVIDER: S-EPMC4360951 | biostudies-literature | 2015 Jan

REPOSITORIES: biostudies-literature

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

Li Qian Q Lin Zhenqiu Z Masoudi Frederick A FA Li Jing J Li Xi X Hernández-Díaz Sonia S Nuti Sudhakar V SV Li Lingling L Wang Qing Q Spertus John A JA Hu Frank B FB Krumholz Harlan M HM Jiang Lixin L

BMC cardiovascular disorders 20150120

<h4>Background</h4>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.<h4>Methods</h4>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 LO ...[more]

PMID: 25603877

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Project description:Language barriers between patients and providers may influence the process and quality of care.To examine the association of language preference with length of stay (LOS) and in-hospital mortality for patients admitted for acute myocardial infarction (AMI).Electronic administrative hospital discharge data for all non-disabled Medicaid beneficiaries age 35 years and older admitted to all acute care California hospitals with a diagnosis of AMI between 1994 and 1998.We used multivariate regression to explore whether observed differences in the hospital LOS and in-hospital mortality between non-English preference (NEP) and English preference (EP) individuals could be explained by individual and/or hospital level factors. We adjusted for patient level characteristics using 24 covariates from a previously validated prediction model of mortality after hospitalization for AMI.Of 12,609 Medicaid patients across 401 California hospitals, 2,757 (22%) had NEP. NEP was associated with a 3.9% increased LOS (95% CI 0.7, 7.1; p = 0.02) in unadjusted analysis and a 3.8% increased LOS (95% CI 0.3, 7.3; p = 0.03) after controlling for patient level characteristics. Differences in LOS were no longer significant after adjusting receipt of cardiac procedure/ surgery (2.8%; 95% CI -0.6, 6.2; p = 0.1) or after adjusting for hospital (0.9%; 95% CI -2.5, 4.3; p = 0.6). Non-English language preference was associated with lower in-hospital mortality in unadjusted analysis (odds ratio [OR] = 0.80; 95% CI 0.69, 0.94; p = 0.005), but was not significant after adjusting for patient level characteristics (adjusted OR [AOR] 0.95; 95% CI 0.78, 1.27; p = 0.6). Adjusting for receipt of cardiac procedure/ surgery (AOR 0.97; 95% CI 0.79, 1.18; p = 0.7) and hospital (AOR 0.97; 95% CI 0.78; 1.21; p = 0.8) did not alter this finding.Language preference is not associated with AMI mortality, and the small increase in length of stay associated with non-English preference is accounted for by hospital level factors. Our results suggest that system level differences are important to consider in studies of the effect of language barriers in the health care setting.

Project description:BackgroundDespite the importance of ST-segment elevation myocardial infarction (STEMI) in China, no nationally representative studies have characterised the clinical profiles, management, and outcomes of this cardiac event during the past decade. We aimed to assess trends in characteristics, treatment, and outcomes for patients with STEMI in China between 2001 and 2011.MethodsIn a retrospective analysis of hospital records, we used a two-stage random sampling design to create a nationally representative sample of patients in China admitted to hospital for STEMI in 3 years (2001, 2006, and 2011). In the first stage, we used a simple random-sampling procedure stratified by economic-geographical region to generate a list of participating hospitals. In the second stage we obtained case data for rates of STEMI, treatments, and baseline characteristics from patients attending each sampled hospital with a systematic sampling approach. We weighted our findings to estimate nationally representative rates and assess changes from 2001 to 2011. This study is registered with ClinicalTrials.gov, number NCT01624883.FindingsWe sampled 175 hospitals (162 participated in the study) and 18,631 acute myocardial infarction admissions, of which 13,815 were STEMI admissions. 12,264 patients were included in analysis of treatments, procedures, and tests, and 11,986 were included in analysis of in-hospital outcomes. Between 2001 and 2011, estimated national rates of hospital admission for STEMI per 100,000 people increased (from 3·5 in 2001, to 7·9 in 2006, to 15·4 in 2011; ptrend<0·0001) and the prevalence of risk factors-including smoking, hypertension, diabetes, and dyslipidaemia-increased. We noted significant increases in use of aspirin within 24 h (79·7% [95% CI 77·9-81·5] in 2001 vs 91·2% [90·5-91·8] in 2011, ptrend<0·0001) and clopidogrel (1·5% [95% CI 1·0-2·1] in 2001 vs 82·1% [81·1-83·0] in 2011, ptrend<0·0001) in patients without documented contraindications. Despite an increase in the use of primary percutaneous coronary intervention (10·6% [95% CI 8·6-12·6] in 2001 vs 28·1% [26·6-29·7] in 2011, ptrend<0·0001), the proportion of patients who did not receive reperfusion did not significantly change (45·3% [95% CI 42·1-48·5] in 2001 vs 44·8% [43·1-46·5] in 2011, ptrend=0·69). The median length of hospital stay decreased from 12 days (IQR 7-18) in 2001 to 10 days (6-14) in 2011 (ptrend<0·0001). Adjusted in-hospital mortality did not significantly change between 2001 and 2011 (odds ratio 0·82, 95% CI 0·62-1·10, ptrend=0·07).InterpretationDuring the past decade in China, hospital admissions for STEMI have risen; in these patients, comorbidities and the intensity of testing and treatment have increased. Quality of care has improved for some treatments, but important gaps persist and in-hospital mortality has not decreased. National efforts are needed to improve the care and outcomes for patients with STEMI in China.FundingNational Health and Family Planning Commission of China.

Dataset Information

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

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

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