title: National trends in hospital length of stay for acute myocardial infarction in China.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.forename: Qian
authors.initials: Q
authors.lastname: Li
authors.forename: Zhenqiu
authors.initials: Z
authors.lastname: Lin
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.forename: Xi
authors.initials: X
authors.lastname: Li
authors.forename: Sonia
authors.initials: S
authors.lastname: Hernández-Díaz
authors.forename: Sudhakar V
authors.initials: SV
authors.lastname: Nuti
authors.forename: Lingling
authors.initials: L
authors.lastname: Li
authors.forename: Qing
authors.initials: Q
authors.lastname: Wang
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.affiliation: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China. jiangl@fwoxford.org.
authors.forename: Lixin
authors.initials: L
authors.lastname: Jiang
mesh_terms: D000368:Aged; D002681:China; D005260:Female; D017052:Hospital Mortality; D006780:Hospitals, Rural; D006786:Hospitals, Urban; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment