Lena M Chen1,2,3,4, Deborah A Levine5,2,4, Rodney Hayward5,2,4, Margueritte Cox6, Phillip J Schulte7, Adam D DeVore6,8, Adrian Hernandez6,8, Paul A Heidenreich9, Clyde Yancy10, Gregg C Fonarow8,11. 1. Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA. lenac@umich.edu. 2. VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA. 3. Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, Michigan, USA. 4. Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan, USA. 5. Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA. 6. Duke Clinical Research Institute, Durham, North Carolina, USA. 7. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA. 8. Department of Medicine, School of Medicine, Duke University, Durham, North Carolina, USA. 9. VA Palo Alto Health Care System, Palo Alto, California, USA. 10. Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. 11. Ahmanson-University of California at Los Angeles Cardiomyopathy Center, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Abstract
BACKGROUND: The Centers for Medicare & Medicaid Services rewards hospitals that have low 30-day riskstandardized mortality rates (RSMR) for heart failure (HF). OBJECTIVE: To describe the use of early comfort care for patients with HF, and whether hospitals that more commonly initiate comfort care have higher 30-day mortality rates. DESIGN: A retrospective, observational study. SETTING: Acute care hospitals in the United States. PATIENTS: A total of 93,920 fee-for-service Medicare beneficiaries admitted with HF from January 2008 to December 2014 to 272 hospitals participating in the Get With The Guidelines-Heart Failure registry. EXPOSURE: Early comfort care (defined as comfort care within 48 hours of hospitalization) rate. MEASUREMENTS: A 30-day RSMR. RESULTS: Hospitals' early comfort care rates were low for patients admitted for HF, with no change over time (2.5% to 2.6%, from 2008 to 2014, P = .56). Rates varied widely (0% to 40%), with 14.3% of hospitals not initiating comfort care for any patients during the first 2 days of hospitalization. Risk-standardized early comfort care rates were not correlated with RSMR (median RSMR = 10.9%, 25th to 75th percentile = 10.1% to 12.0%; Spearman's rank correlation = 0.13; P = .66). CONCLUSIONS: Hospital use of early comfort care for HF varies, has not increased over time, and on average, is not correlated with 30-day RSMR. This suggests that current efforts to lower mortality rates have not had unintended consequences for hospitals that institute early comfort care more commonly than their peers.
BACKGROUND: The Centers for Medicare & Medicaid Services rewards hospitals that have low 30-day riskstandardized mortality rates (RSMR) for heart failure (HF). OBJECTIVE: To describe the use of early comfort care for patients with HF, and whether hospitals that more commonly initiate comfort care have higher 30-day mortality rates. DESIGN: A retrospective, observational study. SETTING: Acute care hospitals in the United States. PATIENTS: A total of 93,920 fee-for-service Medicare beneficiaries admitted with HF from January 2008 to December 2014 to 272 hospitals participating in the Get With The Guidelines-Heart Failure registry. EXPOSURE: Early comfort care (defined as comfort care within 48 hours of hospitalization) rate. MEASUREMENTS: A 30-day RSMR. RESULTS: Hospitals' early comfort care rates were low for patients admitted for HF, with no change over time (2.5% to 2.6%, from 2008 to 2014, P = .56). Rates varied widely (0% to 40%), with 14.3% of hospitals not initiating comfort care for any patients during the first 2 days of hospitalization. Risk-standardized early comfort care rates were not correlated with RSMR (median RSMR = 10.9%, 25th to 75th percentile = 10.1% to 12.0%; Spearman's rank correlation = 0.13; P = .66). CONCLUSIONS: Hospital use of early comfort care for HF varies, has not increased over time, and on average, is not correlated with 30-day RSMR. This suggests that current efforts to lower mortality rates have not had unintended consequences for hospitals that institute early comfort care more commonly than their peers.