The Association of Implemented Care Team Configuration Models with Length of Stay and Charges in Hospitalized Patients with Congestive Heart Failure: A Retrospective Analysis of EHR Data

Background: Clinicians are the conduits of high-quality care delivery. Clinicians have driven advancements in pharmacotherapeutics, devices, and related interventions and improved morbidity and mortality in patients with congestive heart failure over the past decade. Yet, the management of congestive heart failure has become extraordinarily complex and has fueled recommendations from the American Heart Association and the American College of Cardiology to optimize the composition of the care team to reduce the health, economic, and health system burden of high length of stay and hospital charges. Therefore, the purpose of this study was to identify the extent to which care team configuration models of non-specialty clinicians were associated with high length of stay and high charges during the hospitalizations of patients with congestive heart failure. Methods: This study performed a retrospective analysis of EHR-extracted data on 3,099 patients and their encounters from the Arkansas Clinical Data Repository. The data was analyzed using binomial logistic regression in which adjusted odds ratios reflected the association of specific care team configuration models (i.e., combination of clinical roles) with length of stay and hospital charges. Results: Care team configuration models that included physicians, residents, and advanced nurse practitioners were generally associated with greater odds of a patient having a high length of stay or a high charge hospital encounter. Registered nurses were the only specific care team role found within all care team configuration models and has consistently been associated with decreased length of stay and decreased charges. Additionally, the study validated the Van Walraven Elixhauser Comorbidity Score by finding that its quartiles were statistically significantly associated with length of stay and charges. Conclusions: Cardiologists, alone, cannot shoulder the burden of caring for hospitalized patients with congestive heart failure. Care team configuration data within electronic health record systems of hospitals could be an effective method of isolating and tracking high risk patients. Within multidisciplinary care teams, registered nurses may be particularly effective in advancing real-time risk stratification by applying the Van Walraven Elixhauser Comorbidity Score at the point-of-care.