title: Heart failure disease management: impact on hospital care, length of stay, and reimbursement.
abstract: Congestive heart failure (CHF) is a major medical problem with significant hospital costs. The authors developed an inpatient disease management program for CHF in a community hospital setting to determine if it is possible to: 1) increase implementation of Agency for Health Care Policy and Research criteria for CHF; 2) improve the quality of patient care, while lowering length of stay and treatment cost for CHF; and 3) maintain nursing staff satisfaction. The program encompassed a clinical pathway incorporating Agency for Health Care Policy and Research criteria for CHF, CHF education, and patient educational materials. When compared to "unmanaged" patients (n=197) not participating in the algorithm due to physician choice, "managed" patients (n=396) had significantly increased documentation of left ventricular dysfunction and of angiotensin-converting enzyme inhibitor use. In contrast to unmanaged patients, managed patients had a significantly lower length of stay (3.9+/-2.2 vs. 6.1+/-2.8 days; p<0.0001) with a significant reduction in cost per patient ($4404+/-$1989 vs. $6828+/-$3347; p<0.0001). These changes were sustained in follow-up over 1 year and were associated with an improvement in nursing staff education and nursing care. Thus, a disease management program for CHF can be successfully implemented in a general community hospital setting, achieving improved compliance with Agency for Health Care Policy and Research treatment criteria and enhancing patient care, while reducing length of stay and cost.
authors.affiliation: Michigan Institute for Heart Failure and Transplant Care, Botsford General Hospital, Farmington Hills, MI, USA.
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Discher
authors.forename: Dahlia
authors.initials: D
authors.lastname: Klein
authors.forename: Lisa
authors.initials: L
authors.lastname: Pierce
authors.forename: Arlene B
authors.initials: AB
authors.lastname: Levine
authors.forename: T Barry
authors.initials: TB
authors.lastname: Levine
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use; D019468:Disease Management; D018588:Fee-for-Service Plans / Q000191:economics; D005500:Follow-Up Studies; D006333:Heart Failure / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007588:Job Satisfaction; D007902:Length of Stay / Q000191:economics; D009741:Nursing Staff, Hospital / Q000191:economics / Q000523:psychology; D005791:Patient Care / Q000191:economics; D010414:Pennsylvania; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000191:economics / Q000503:physiopathology / Q000628:therapy
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors