In Busy Hospitals, Congestive Heart Failure Outcomes Better

Lower mortality rates and fewer readmissions, but higher costs in high-volume hospitals

THURSDAY, Jan. 20 (HealthDay News) -- Experience with treating congestive heart failure, as measured by hospital volume, is associated with decreased mortality and fewer readmissions; but the cost per patient is higher, according to a study published in the Jan. 18 issue of Annals of Internal Medicine.

Karen E. Joynt, M.D., M.P.H., of the Harvard School of Public Health in Boston, and colleagues conducted a retrospective cohort study of patients aged 65 years and older who were discharged from 4,095 U.S. hospitals with a primary discharge diagnosis of congestive heart failure. Mortality rates, readmission rates, cost per discharge, and Hospital Quality Alliance congestive heart failure process measures were examined. Data from National Medicare claims were used to identify the relationship between hospital case volume and quality, outcome, and cost for patients.

The researchers found that high-volume hospitals performed significantly better than medium- or low-volume hospitals (89.1, 87.0, and 80.2 percent, respectively), for performance on the process measures. Within the low-volume hospital group, patients had lower mortality, lower readmission, and higher costs where the hospital had higher case volumes. Similar, though smaller, relationships were identified for mortality and costs in the medium- and high-volume hospital groups.

"Hospitals with greater experience caring for patients with congestive heart failure provide better care, with better outcomes, to a sicker patient population—but do so at a higher cost," the authors write.

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