title: "Phenotyping" hospital value of care for patients with heart failure.
abstract: OBJECTIVE
  To characterize hospitals based on patterns of their combined financial and clinical outcomes for heart failure hospitalizations longitudinally.
  
  
  METHODS
  Detailed cost and administrative data on hospitalizations for heart failure from 424 hospitals in the 2005-2011 Premier database.
  
  
  METHODS
  Using a mixture modeling approach, we identified groups of hospitals with distinct joint trajectories of risk-standardized cost (RSC) per hospitalization and risk-standardized in-hospital mortality rate (RSMR), and assessed hospital characteristics associated with the distinct patterns using multinomial logistic regression.
  
  
  RESULTS
  During 2005-2011, mean hospital RSC decreased from $12,003 to $10,782, while mean hospital RSMR declined from 3.9 to 3.2 percent. We identified five distinct hospital patterns: highest cost and low mortality (3.2 percent of the hospitals), high cost and low mortality (20.4 percent), medium cost and low mortality (34.6 percent), medium cost and high mortality (6.2 percent), and low cost and low mortality (35.6 percent). Longer hospital stay and greater use of intensive care unit and surgical procedures were associated with phenotypes with higher costs or greater mortality.
  
  
  CONCLUSIONS
  Hospitals vary substantially in the joint longitudinal patterns of cost and mortality, suggesting marked difference in value of care. Understanding determinants of the variation will inform strategies for improving the value of hospital care.
authors: Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT.
authors: Xiao
authors: X
authors: Xu
authors: Shu-Xia
authors: SX
authors: Li
authors: Haiqun
authors: H
authors: Lin
authors: Sharon-Lise T
authors: SL
authors: Normand
authors: Nancy
authors: N
authors: Kim
authors: Lesli S
authors: LS
authors: Ott
authors: Tara
authors: T
authors: Lagu
authors: Michael
authors: M
authors: Duan
authors: Eugene A
authors: EA
authors: Kroch
authors: Harlan M
authors: HM
authors: Krumholz
mesh_terms: D003365:Costs and Cost Analysis; D004469:Economics, Hospital; D006333:Heart Failure / Q000628:therapy*; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics*; D006761:Hospitals / Q000145:classification* / Q000592:standards*; D006801:Humans; D011787:Quality of Health Care / Q000145:classification* / Q000191:economics*
keywords: Cost; heart failure; mortality; trajectory; value of care