1993 vs 2006 CHF住院天數從8.8 -> 6.3天，30天死亡率(12->10%)in hospital death(8->4%)，有進步，然後咧?

這是趨勢，less LOS days, more re-admission rate, 但整體前30天死亡率的確有進步，但後來呢? 每一種慢性病不也如此
請參照
http://jfliu-chestman.blogspot.com/2010/07/ltac-8850.html

COPD, DM, CVA 病人，LTAC利用率越來越高

Treating Heart Failure in Hospitalized Patients: How Are We Doing?

A 14-year review of Medicare patients reveals significant secular trends toward shorter length of stay and lower 30-day mortality but more readmissions.

During the past decade, we have witnessed substantial shortening in hospital length of stay for patients with heart failure. Although better medical therapy and new cardiac devices have resulted in improved long-term outcomes in these patients, whether shorter length of stay puts patients at risk for short-term adverse events is unclear.

Researchers performed a retrospective observational study on data from almost 7 million fee-for-service Medicare patients (age, ≥65) who were hospitalized with heart failure from 1993 to 2006. During the study, mean length of stay decreased by 2.5 days (from 8.8 days in 1993 to 6.3 days in 2006), and in-hospital and 30-day mortality rates decreased from 8.5% to 4.3% and from 12.8% to 10.7%, respectively. Discharges to home or home-care services decreased from 74% to 67%, and discharges to skilled nursing facilities increased from 13% to 20%. The 30-day readmission rate increased from 17% to 20%.

Comment: At first glance, quality of care seems to have improved for Medicare patients with heart failure, because in-hospital and 30-day mortality were lower by 2006. However, the shorter hospital length of stay during the 14-year study came at the cost of more admissions to nursing home facilities and a higher percentage of patients who required hospital readmission. (The high rate of readmissions among Medicare beneficiaries has been documented previously [JW Hosp Med Apr 1 2009]). The best treatment model for older patients with heart failure is still a work in progress and will require more emphasis on the transition of care from hospital to home.

— Neil H. Winawer, MD, FHM

Published in Journal Watch Hospital Medicine July 12, 2010
Citation(s):

Bueno H et al. Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993-2006. JAMA 2010 Jun 2; 303:2141. (http://dx.doi.org/10.1001/jama.2010.748)

* Original article (Subscription may be required)
* Medline abstract (Free)

http://www.ncbi.nlm.nih.gov/pubmed/20516414?dopt=Abstract

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