January 20, 2015BMC Cardiovascular Disorders28 citationsOpen Access
National trends in hospital length of stay for acute myocardial infarction in China
Key Result
Hospital length of stay for acute myocardial infarction in China decreased from 14.6 days in 2001 to 11.9 days in 2011, with Central region hospitals demonstrating a 1.6-day shorter risk-standardized length of stay compared to Eastern region hospitals.
Study Design
Type
Observational (n=12,706)
Multicenter
Yes
Structured PICO
P
Population
12,706 patients hospitalized for acute myocardial infarction (AMI) in China across 160 hospitals during 2001, 2006, and 2011. Mean age 64.4 years, 29.7% female.
O
Outcome
Hospital length of stay (LOS) and risk-standardized LOS (RS-LOS)
Hospital length of stay for AMI in China has decreased over a decade but remains prolonged compared to international standards, with significant unexplained inter-hospital variation.
Main Result
Effect estimate: Difference -1.6 days (95% CI -2.9, -0.2)
p-value: p=0.02
Limitations
- Lack of information on certain hospital characteristics, such as the establishment of AMI clinical pathways.
- Cross-sectional nature prevented examining the association between length of stay and patient prognoses like readmission or post-discharge quality of life.
- Potential uneven quality of medical chart documentation across different hospitals.
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.
Cite This Study
Li et al. (2015) conducted an observational in Acute myocardial infarction (AMI) (n=12,706). Central region hospitals vs. Eastern region hospitals was evaluated on Risk-standardized length of stay (RS-LOS) (Difference -1.6 days, 95% CI -2.9, -0.2, p=0.02). Hospital length of stay for acute myocardial infarction in China decreased from 14.6 days in 2001 to 11.9 days in 2011, with Central region hospitals demonstrating a 1.6-day shorter risk-standardized length of stay compared to Eastern region hospitals.