Related Experiment Video
Updated: Mar 26, 2026
Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
Published on: June 10, 2025
Outcomes trends for acute myocardial infarction, congestive heart failure, and pneumonia, 2005-2009
Chapy Venkatesan1, Alita Mishra, Amanda Morgan
13300 Gallows Rd, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA 22042.
Insights
Hospital quality reporting for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia shows improved outcomes and resource efficiency. Despite increased patient complexity, in-hospital mortality decreased, and costs stabilized or decreased.
Area of Science:
- Healthcare Quality
- Health Services Research
- Hospital Management
Background:
- The Centers for Medicare & Medicaid Services (CMS) core conditions, including acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia, are critical for hospital quality reporting and value-based purchasing.
- Assessing national trends in in-hospital mortality and resource utilization for these core conditions is essential for evaluating healthcare performance.
Purpose of the Study:
- To analyze national trends in in-hospital mortality and resource utilization for AMI, CHF, and pneumonia from 2005 to 2009.
- To identify changes in length of stay, cost, charges, patient severity, and the number of diagnoses and procedures over time for these core conditions.
Main Methods:
- A time series analysis was conducted using data from the Nationwide Inpatient Sample (NIS) covering 5 yearly cycles (2005-2009).
- Statistical methods included chi-square tests and t-tests to identify significant changes in parameters over time.
- Logistic and linear regression models were employed to determine factors associated with in-hospital deaths, hospital charges, and length of stay.
Main Results:
- In-hospital mortality rates declined for AMI, CHF, and pneumonia.
- Length of stay decreased for AMI and pneumonia, while remaining unchanged for CHF.
- Inflation-adjusted charges per case increased for all three conditions, but inflation-adjusted costs per case decreased for CHF and remained stable for AMI and pneumonia.
- The proportion of patients with increased complexity and mortality risk rose across all three diagnoses.
- The number of diagnoses and procedures were significant predictors of length of stay, cost, and charges.
Conclusions:
- Despite increasing patient complexity and mortality risk, quality of inpatient care and resource utilization for CMS core conditions demonstrated improvements.
- Further investigation is warranted to elucidate the specific drivers behind these observed improvements in healthcare quality and efficiency.
Objectives:
The CMS core conditions-acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia-are a focus of hospital quality reporting and its value-based purchasing program. The study's purpose was to assess national trends of in-hospital mortality and resource utilization for these core measures.
Study Design:
A time series study using outcomes from the 5 yearly cycles of the Nationwide Inpatient Sample (2005-2009).
Methods:
Stratum-specific χ2 test for independence (binary or categorical parameters) or t test for a contrasted mean (continuous parameters) were used to identify parameters that changed significantly over time (in-hospital mortality, length of stay, cost, charges, severity of illness, diagnoses per case, procedures per case). Multiple logistic and linear regression models were used to identify factors associated with in-hospital deaths, hospital charges, and length of stay (LOS).
Results:
In-hospital mortality decreased for AMI, CHF, and pneumonia. LOS was unchanged for CHF, but decreased for AMI and pneumonia. Average inflation-adjusted charges per case increased for all 3 conditions, while the average inflation-adjusted cost per case decreased for CHF and remained stable for AMI and pneumonia. The proportion of patients with extreme disability and extreme likelihood of dying, as defined by All-Patient-Refined Diagnosis Related Group, increased for all 3 diagnoses. The number of diagnoses and procedures were independently associated with LOS, cost, and charges for all 3 conditions.
Conclusions:
Many measures of quality of inpatient care and resource utilization for CMS core conditions improved despite increases in patient complexity and risk of mortality. Further research is necessary to determine the exact causes of these improvements.
More Related Videos
14:35Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
Related Concept Videos
01:30Pneumonia III: Complications and Assessment
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
01:21Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
01:21Acute Respiratory Failure-I
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...