title: Relationship between hospital length of stay and quality of care in patients with congestive heart failure.
abstract: OBJECTIVE
  To determine the relationship between hospital length of stay (LOS) and quality of care in patients admitted for congestive heart failure (CHF).
  
  
  METHODS
  This observational study was conducted in the medical wards of the Geneva University Hospitals, Geneva, Switzerland. A random sample of 371 patients was drawn from the 1084 patients discharged alive with a principal diagnosis of CHF between January 1997 and December 1998. Explicit criteria grouped into three scores were used to assess the quality of processes of care: admission work-up (admission score); evaluation and treatment during the stay (treatment score); and readiness for discharge (discharge score). The association between LOS and quality of care was analysed using linear regression with adjustment for clinical characteristics.
  
  
  RESULTS
  The mean proportion of criteria met were 80% for the admission score, 66% for the treatment score, and 76% for the discharge score. Mean (SD) LOS was 13.2 (8.8) days. The admission score was not associated with LOS, but the treatment score increased by 0.5% (95% CI 0.3 to 0.7; p < 0.001) with each additional day in hospital and the discharge score increased by 2.5% (95% CI 1.6 to 3.3; p < 0.001) per day from admission to day 10 but remained unchanged thereafter. Adjustment for potential confounders did not substantially modify these relationships.
  
  
  CONCLUSIONS
  In patients with CHF there is a significant association between LOS and the quality of the treatment provided, as well as with readiness for discharge. Appropriate reorganisation of processes of care should accompany attempts at reducing LOS to avoid detrimental effects on quality of care.
authors.affiliation: Group de Recherche et d'Analyse en Sytèmes, Soins Hospitaliers (GRASSH), Geneva University Hospitals. michel.picard-kossovsky@hcuge.ch
authors.forename: M P
authors.initials: MP
authors.lastname: Kossovsky
authors.forename: F P
authors.initials: FP
authors.lastname: Sarasin
authors.forename: P
authors.initials: P
authors.lastname: Chopard
authors.forename: M
authors.initials: M
authors.lastname: Louis-Simonet
authors.forename: P
authors.initials: P
authors.lastname: Sigaud
authors.forename: T V
authors.initials: TV
authors.lastname: Perneger
authors.forename: J M
authors.initials: JM
authors.lastname: Gaspoz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006302:Health Services Research; D006333:Heart Failure / Q000628:therapy*; D006785:Hospitals, University / Q000592:standards* / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care; D013557:Switzerland