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: Qian Li, Zhenqiu Lin, Frederick A Masoudi, Jing Li, Xi Li, Sonia Hernández-Díaz, Sudhakar V Nuti, Lingling Li, Qing Wang, John A Spertus, Frank B Hu, Harlan M Krumholz, Lixin Jiang
• Journal: BMC cardiovascular disorders (BMC Cardiovasc Disord) Vol. 15 Pg. 9 (Jan 20 2015) ISSN: 1471-2261 [Electronic] England
• PMID: 25603877 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Aged
• China
• Female
• Hospital Mortality
• Hospitals, Rural
• Hospitals, Urban
• Humans
• Length of Stay
• Male
• Middle Aged
• Myocardial Infarction (diagnosis, mortality, therapy)
• Retrospective Studies
• Risk Assessment