A COMPARISON OF OUTCOMES OF PATIENTS WITH CONGESTIVE HEART FAILURE AND PNEUMONIA AMONG TEACHING AND NONTEACHING SERVICES

Ramanuj Chakravarty, MD*;Getu Teressa, MD, PHD;Jie Yang, PHD;Mengru Zhang, MS;Sadia Abbasi, MD and Joesph Laver, MD, Stony Brook University Medical Center, Stony Brook, NY

Meeting: Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.

Abstract number: 69

Categories: Outcomes Research, Research Abstracts

Keywords: , , ,

Background:   Congestive heart failure (CHF) and pneumonia are amongst the leading causes of hospitalization in the United States.  Although a growing number of hospitals use both teaching and nonteaching hospitalist services for patient care, the differences in clinical outcomes and efficiency between these two services is not clearly known. The aim of this study was to compare inpatient mortality and length of hospital stay in CHF and pneumonia patients admitted to teaching and nonteaching hospitalist services. 

Methods: Consecutive patients admitted to teaching and nonteaching hospitalist services in a tertiary care hospital with a primary diagnosis of CHF or pneumonia were assessed for in-hospital mortality and length of hospital stay (LOS). Categorical variables were expressed as counts (percentages) and compared using Chi-square test.  Linear regression models were used to examine the risk adjusted difference in LOS in both Pneumonia and CHF patients using Medical-Severity – Diagnosis Related Groups weights/Case Mix Index (MS-DRG Weight/CMI) as measures of illness severity and clinical complexity and further adjusting for home use of Angiotensin-Converting Enzyme (ACE)-Inhibitors and Angiotensin II Receptor Blockers (ARBs) for CHF patients. Logistic regression models were used to examine the difference in in-hospital death. P-value ≤ 0.05 was considered statistically significant. 

Results: A final cohort of 384 CHF and 310 pneumonia cases were identified from September to December 2014.  CHF patients managed by the non-teaching team had less in-hospital death (1.46% vs. 5.45%, P-value=0.0364. Adjusted Odds Ratio for in-hospital mortality for CHF patients managed in non-teaching vs. teaching services was: 0.196, 95% CI: 0.050-0.770, P = 0.0196 after adjusting for severity of illness; 0.248, 95% CI: 0.068-0.899, P =0.0338 after adjusting for home use of ACE-inhibitors; and 0.192, 95% CI: 0.071-0.929, P =0.0382 after adjusting for home use of ARBs). There was no difference in mortality for pneumonia patients admitted to teaching and non-teaching services. Patients with pneumonia admitted to nonteaching service had longer LOS (6.00 days (95% CI: 5.46-6.59) vs. 4.94 days (95% CI: 4.18-5.82, P = 0.0450). There were no statistically significance differences between services with respect to LOS and home use of ACE-I and ARBs for patients admitted for CHF.  

Conclusions: Patients with CHF admitted to nonteaching hospitalists services had lower adjusted in-hospital mortality compared to similar cohorts admitted to teaching services. Patients with pneumonia admitted to teaching hospitalists services had similar inpatient morality but lower LOS compared to those admitted to nonteaching services. 

To cite this abstract:

Chakravarty, R; Teressa, G; Yang, J; Zhang, M; Abbasi, S; Laver, J . A COMPARISON OF OUTCOMES OF PATIENTS WITH CONGESTIVE HEART FAILURE AND PNEUMONIA AMONG TEACHING AND NONTEACHING SERVICES. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 69. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/a-comparison-of-outcomes-of-patients-with-congestive-heart-failure-and-pneumonia-among-teaching-and-nonteaching-services/. Accessed May 20, 2019.

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