Study: Shortened hospital stays may bring increased risks of return

The Wall Street Journal: "To save costs, hospitals for years have been discharging patients after shorter stays. But at the same time more people are having to return to hospital for additional care within a month of their initial treatment, according to a major new study of Medicare heart-failure patients." These findings call attention to the possibility "that the drive to reduce the length of time patients spend in hospitals—a key cost-containment strategy for both government and private insurers—may have backfired" at least in regard to heart-failure admissions. "The study didn't look at actual expenditures so it didn't document that shorter stays actually led to higher costs" (Winslow, 6/2).

U.S. News & World Report/Health Day: "While in-hospital death rates have decreased, 'the results are very mixed, and overall you could say that they are worse off,' said Dr. Harlan M. Krumholz, professor of medicine at Yale University and a member of a team reporting the finding in the June 2 issue of the Journal of the American Medical Association. In the study of nearly 7 million Medicare-financed hospitalizations for heart failure, the progressive loss of ability to pump blood, the researchers found that the average length of stay decreased by 2.5 days, from 8.8 days in 1993 to 6.3 days in 2006. The in-hospital death rate was nearly halved, dropping from 8.5 percent to 4.3 percent. … It's not clear that there is a direct relationship between a shorter hospital stay and more post-hospital deaths and readmissions, said Dr. Adrian F. Hernandez, an assistant professor of medicine at Duke University, who recently led a study showing that hospitals that took pains to prepare heart failure patients for home care had better out-of-hospital results" (Edelson, 6/1).

WRAL: "Over the past 13 years, medications and quality of care have been improving for heart failure patients in hospitals, experts say. An increasing number are surviving their hospital stay, which doctors say has been shortened by four days. Though success inside the hospital is better, it's when patients leave that there is a concern. … Researchers say, going forward, it's important to look at all aspects of care, not just what happens to heart failure patients while they're hospitalized" (Hanrahan, 6/1).

WebMD: "The current Medicare fee-for-service system rewards hospitals for discharging patients sooner, rather than later, but the impact of shorter hospitalizations on patient outcomes has not been fully understood. … 'Most people would not consider it progress to get out of the hospital sooner when that is coupled with a 20% increase in readmissions and a 53% increase in nursing home admissions,' Krumholz says" (Boyles, 6/2).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.