“Phenotyping” Hospital Value of Care for Patients with Heart Failure

Authors

  • Xiao Xu Ph.D.,

    1. Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
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  • Shu-Xia Li Ph.D.,

    1. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
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  • Haiqun Lin M.D., Ph.D.,

    1. Department of Biostatistics, Yale University School of Public Health, New Haven, CT
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  • Sharon-Lise T. Normand Ph.D.,

    1. Department of Health Care Policy, Harvard Medical School, Boston, MA
    2. Department of Biostatistics, Harvard School of Public Health, Boston, MA
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  • Nancy Kim M.D.,

    1. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
    2. Section of General Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
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  • Lesli S. Ott M.A.,

    1. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
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  • Tara Lagu M.D., M.P.H.,

    1. Division of General Medicine, Tufts University School of Medicine, Boston, MA
    2. Baystate Medical Center, Springfield, MA
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  • Michael Duan M.S.,

    1. Premier, Inc., Charlotte, NC
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  • Eugene A. Kroch Ph.D.,

    1. Premier, Inc., Charlotte, NC
    2. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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  • Harlan M. Krumholz M.D., S.M.

    Corresponding author
    1. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
    2. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
    3. Department of Health Policy and Management, Yale University School of Public Health, New Haven, CT
    • Address correspondence to Harlan M. Krumholz, M.D., S.M., Yale/YNHH Center for Outcomes Research and Evaluation, 1 Church St., Suite #200, New Haven, CT 06510; e-mail: harlan.krumholz@yale.edu.

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Abstract

Objective

To characterize hospitals based on patterns of their combined financial and clinical outcomes for heart failure hospitalizations longitudinally.

Data Source

Detailed cost and administrative data on hospitalizations for heart failure from 424 hospitals in the 2005–2011 Premier database.

Study Design

Using a mixture modeling approach, we identified groups of hospitals with distinct joint trajectories of risk-standardized cost (RSC) per hospitalization and risk-standardized in-hospital mortality rate (RSMR), and assessed hospital characteristics associated with the distinct patterns using multinomial logistic regression.

Principal Findings

During 2005–2011, mean hospital RSC decreased from $12,003 to $10,782, while mean hospital RSMR declined from 3.9 to 3.2 percent. We identified five distinct hospital patterns: highest cost and low mortality (3.2 percent of the hospitals), high cost and low mortality (20.4 percent), medium cost and low mortality (34.6 percent), medium cost and high mortality (6.2 percent), and low cost and low mortality (35.6 percent). Longer hospital stay and greater use of intensive care unit and surgical procedures were associated with phenotypes with higher costs or greater mortality.

Conclusions

Hospitals vary substantially in the joint longitudinal patterns of cost and mortality, suggesting marked difference in value of care. Understanding determinants of the variation will inform strategies for improving the value of hospital care.

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