Effect of improved disease management strategies on hospital length of stay in the treatment of congestive heart failure.

Congestive heart failure (CHF) afflicts more than 4.6 million people in the United States and increases at a rate of 400,000 newly diagnosed patients per year. With more than 1.5 million hospital admissions per year attributed to CHF, it is the number one cause of hospitalization. Hospital length of stay (LOS) is one key determinant of greater hospital costs and has been the focus in some economic studies of CHF patients. In the present study, the potential economic benefits for hospitals from the implementation of improved disease-specific management programs in the treatment of CHF have been quantified in terms of LOS. We estimated the potential effects of disease management on LOS as a residual variation across hospitals, controlling for the effects of patient-specific characteristics, including severity of disease, health status, insurance status, and comorbidities. The study entry criteria and random sample selection yielded 5242 records for analysis. The average LOS was 7.1 days. The fixed effects or disease management practices across hospitals contribute to the explanatory power of the model by 4%. The 104 hospital-specific fixed effects measuring the potential impact of the differences in disease management relative to the reference hospital had values ranging from-3.41 to 4.33 days, for a total spread of 7.74 days, even after controlling for all other factors. The analysis suggests that the potential gain in profits for hospitals reimbursed on a per-case basis may be substantial, if disease management strategies practiced by those hospitals that lie to the left of the mean LOS were used by those that lie to the right of the mean LOS.