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Biomedical subjects

L J Lynch

Publications and source records attributed to L J Lynch.

12 recordsLinked to original sources
PubMed1997

Predictors and determinants of hospital length of stay in congestive heart failure in ten community hospitals.

BACKGROUND: Little is known about the actual determinants of hospital length of stay (LOS) among patients admitted with congestive heart failure (CHF), in spite of its economic impact. To increase understanding of these factors, we examined the demographic, clinical, laboratory, and treatment characteristics of patients hospitalized with decompensated CHF. METHODS: The charts of consecutive patients admitted to 10 acute care community hospitals during 1995 were reviewed. The relationship between LOS and more than 140 patient-specific variables were examined. First, patient characteristics identifiable within the first 24 hours of hospitalization were examined for their relationship with LOS. Then, variables indicative of the processes of care and response to treatment were studied. Finally, administrative data were added to yield the final model for LOS. RESULTS: During the study period 1402 patients were admitted to the participating centers. The patients were predominantly elderly with moderately severe or severe CHF. With stepwise multiple linear regression, 5% of the variation in LOS could be explained by baseline characteristics alone (r = 0.22, p < 0.0001). When treatment and response variables were added to this model, 15% of the variation in LOS could be explained (r = 0.39, p < 0.0001). When administrative data were added, the final model explained 31% of the variation in LOS (r = 0.56, p < 0.0001). CONCLUSIONS: We conclude that LOS among patients hospitalized with decompensated CHF is partially related to patient demographics, severity of illness, management modalities, response to treatment, and administrative data. However, significant residual variation in LOS exists, which cannot be explained by these factors. These observations may be of value in the design and implementation of initiatives aimed at reducing resource utilization and improving quality of care in CHF.

Age Factors↗
PubMed1996

Patterns of angiotensin-converting enzyme inhibitor use in congestive heart failure in two community hospitals.

Because they provide relief of symptoms and reduce mortality, angiotensin-converting enzyme (ACE) inhibitors have become a highly recommended part of the pharmacologic treatment of patients with congestive heart failure (CHF). Although clinical trials suggest that 80% to 90% of patients with CHF tolerate ACE inhibitors, recent surveys reveal that for fewer than this number of patients are actually receiving these drugs. The reasons for this discrepancy are not known. To better understand physician-prescribing behavior, the current study examined the demographic, clinical, laboratory, and medical care characteristics of patients treated and not treated with ACE inhibitors during hospitalization for decompensated CHF. The charts of a consecutive series of patients admitted to 2 acute care hospitals during 1992 (n = 424) were reviewed and comparisons made between those receiving and not receiving ACE inhibitors at the time of hospital admission and hospital discharge. In addition, measures of in-hospital and postdischarge outcome were compared between the groups. The results revealed significant differences in certain demographic variables (e.g., patient age), clinical measures (e.g., left ventricular ejection fraction and serum creatinine), management issues (e.g., documentation of left ventricular function and documentation of etiology of CHF), and treatment strategies (e.g., ancillary drug use). Few differences were noted in measures of severity of CHF (e.g., New York Heart Association functional class and serum sodium level). Death rates were significantly higher for those not receiving ACE inhibitors. Patterns that emerged that could explain under-prescription ACE inhibitors included older age, worse renal function, left ventricular diastolic dysfunction, use of alternate vasodilators, and overall less intense medical management. Programs to educate care providers regarding the proper use of ACE inhibitors in CHF are recommended.

Aged↗
PubMed1996

Does QI work? The Management to Improve Survival in Congestive Heart Failure (MISCHF) study.

BACKGROUND: In an ongoing study, a randomized, controlled trial is being conducted on the effects of a collaborative quality improvement program on practice patterns and patient outcomes regarding congestive heart failure (CHF) in community hospitals in upstate New York. CHF is associated with severe morbidity and mortality, with annual rates of death exceeding 50% among patients with the most severe disease. PHASE I: Phase I of the study was designed to model the processes of care and outcomes, develop valid disease-specific risk adjustment techniques, and target areas for quality improvement (QI) intervention. Beginning April 1, 1995, and ending December 31, 1995, baseline data were collected during hospitalization and for six months postdischarge for all 1,402 consecutive patients assigned diagnosis-related groups (DRGs) 127 and 124. Preliminary analyses revealed high rates of hospital readmission (46%) and postdischarge death (18%), with significant interhospital variation. QI INITIATIVES: Initiatives include educational programs on CHF, feedback of Phase I data to clinicians and administrators, design and implementation of a clinical care pathway, improvement of the emergency department (prehospital) phase of CHF management, and improvement in patient education and discharge planning. SUMMARY AND CONCLUSIONS: The study suggests that community hospitals, many without extensive experience in clinical investigation, can voluntarily collaborate to design and implement a timely QI initiative that is evidence based, clinically relevant, and scientifically sound. Preliminary results have led to better understanding of the processes of care and determinants of outcome for patients with heart failure. Phase II of the study should yield insights into the providers' response to a locally derived intervention and the effects of such a program on patient outcomes.

Cardiology Service, Hospital↗
PubMedDate not supplied

The relationship between hospital length of stay and rate of death in heart failure.

OBJECTIVE: To study the relationship between length of stay (LOS) and the rate of death among patients hospitalized with congestive heart failure (CHF). DESIGN: A retrospective, observational study. SETTING: Fifteen acute care community hospitals in upstate New York. PATIENTS: Three thousand nine hundred fourteen patients whose principal billing diagnosis was diagnosis-related group number 127 (CHF and shock). OUTCOME MEASURES: Mean total LOS and hospital death rate. VARIABLES: Mean number of nonacute care hospital days per patient, mean number of acute care days (acute LOS) per patient, cases per hospital, hospital bed capacity, and the presence of a cardiac catheterization laboratory, cardiac surgical services, or a medical residency training program. An index of severity of illness and a severity-weighted expected LOS were calculated for each patient as well. RESULTS: Significant variability in mean total LOS (7.6 to 12.7 days), mean acute LOS (7.1 to 10.3 days), and death rates (4.3 to 12.0%) was noted among the centers. Minimal variation in mean expected LOS (5.2 to 6.1 days) and mean severity score (2.8 to 3.3) was observed. Mean total LOS (r = 0.14, p = 0.61) and acute LOS (r = 0.11, p = 0.69) were not related significantly to death rate for the 15 centers. When the hospitals were separated into tertiles based on rank order of total LOS and acute LOS, no differences among the subgroups were noted in the number of cases per hospital, deaths per hospital, death rates, expected LOS, and severity scores, Interhospital variation in total LOS was partially explained by the care of patients who did not require acute hospitalization. CONCLUSIONS: Significant interhospital variation exists in LOS and death rates for patients admitted with CHF; these two measures are not related to each another. This variability in outcome cannot be explained by severity of illness case-mix alone; significant variation in the processes and effectiveness of patient care may exist.

Aged↗
PubMedDate not supplied

General practice.

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Delivery of Health Care, Integrated↗