title: Relation Between Hospital Length of Stay and Quality of Care in Patients With Acute Coronary Syndromes (from the American Heart Association's Get With the Guidelines--Coronary Artery Disease Data Set).
abstract: Worries regarding short length of stay (LOS) adversely impacting quality of care prompted us to assess the relation between hospital LOS and inpatient guideline adherence in patients with acute coronary syndrome. We used the American Heart Association's Get with The Guidelines (GWTG)--Coronary Artery Disease data set. Data were collected from January 2, 2000, to March 21, 2010, for patients with acute coronary syndrome from 405 different sites. Of the 119,398 patients in the study, the mean LOS was 5.5 days with a median of 4 days. There was no difference in the LOS on the basis of hospital size, hospital type, or cardiac surgery availability. The population with an LOS <4 days were younger (63.8 ± 14.1 vs 70 ± 14.5, p <0.0001), men (63.8% vs 55.3%, p <0.0001) and had fewer clinical co-morbidities. The overall adherence was high in the GWTG participating hospitals. Those with the LOS <4 days were more likely to receive aspirin (adjusted odds ratio [OR] 1.12, 95% CI 1.06 to 1.19; p <0.001), clopidogrel (OR 1.77, 95% CI 1.60 to 1.95; p <0.001), lipid-lowering therapy if indicated (OR 1.13, 95% CI 1.05 to 1.21; p <0.001), angiotensin-converting enzyme inhibitor or angiotensin receptor blocker for left ventricular systolic dysfunction (OR 1.10, 95% CI 1.01 to 1.21; p = 0.04) and smoking cessation counseling (OR 1.17, 95% CI 1.1 to 1.24; p <0.001) compared to those with the LOS ≥ 4 days. In contrast, those with the LOS <4 days were less likely to receive beta blockers (OR 0.88, 95% CI 0.84 to 0.93; p <0.001). The odds of receiving defect-free care were greater for patients with the LOS <4 days (OR 1.15, 95% CI 1.1 to 1.21; p <0.001). In conclusion, in GWTG participating hospitals, a shorter LOS did not appear to adversely affect adherence to discharge quality of care measures.
authors.affiliation: Department of Medicine, Western Connecticut Health Network, Danbury, Connecticut.
authors.forename: Sumit
authors.initials: S
authors.lastname: Tickoo
authors.affiliation: Department of Medicine, Western Connecticut Health Network, Danbury, Connecticut.
authors.forename: Adarsh
authors.initials: A
authors.lastname: Bhardwaj
authors.affiliation: Department of Medicine, Los Angeles Medical Center, University of California, Los Angeles, California.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Li
authors.initials: L
authors.lastname: Liang
authors.affiliation: Department of Medicine, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Harvard Clinical Research Institute, Brigham and Women's Hosptial, Boston, Massachusetts. Electronic address: christopher.cannon@hcri.harvard.edu.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000572:American Heart Association; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality / Q000639:trends; D006761:Hospitals; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011787:Quality of Health Care; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology