Length of stay for acute myocardial infarction patients in eastern rural area in China from 2001 to 2011

Abstract

Objective To describe the average hospital length of stay (LOS) and its trend and variation in rural areas of eastern China, and to analyze the hospital characteristics associated with LOS. Methods We collected the data of representative in-patients with acute myocardial infarction (AMI) in eastern rural areas in 2001, 2006 and 2011 by random sampling. The hospital length of stay and its changing trend were described. Hospitals were divided into tertiles-high, middle, low-based on the median LOS; the characteristics of patients, AMI treatment, as well as outcome were compared across the tertiles of hospitals. The association between the hospital characteristics and LOS was analyzed after adjusting for patient-level characteristics. Results We examined the medical records of 2 361 patients hospitalized with AMI from 32 hospitals in the eastern rural areas. The average LOS were (14.7±10)days in 2001, (12.4±10.1)days in 2006, and (11.9±6.5)days in 2011, decreasing annually (F=15.41, P<0.001). When looking at the cohort on the three time points (2001, 2006, and 2011) with ruling out the factors of complication during hospitalization and the LOS outliers, the average LOS still indicated an trend of decline (F=5.44, P=0.02). However, after adjusting for the differences in patient factors, few marked differences in LOS were found over the years (P=0.89). Across the three tertiles of hospitals, categorized as high, middle and low based on the average LOS, a statistical difference existed in the use rate of statin during hospitalization (P<0.05). After adjusting for patient-level characteristics, the hospital characteristics were not significantly associated with the average LOS. Conclusions This study showed a trend of an annual decrease of LOS in patients hospitalized with AMI from the eastern rural areas in China. There is nevertheless still significant room for further improvement. Therefore, it is crucial to effectively advance the standardization for AMI patients of diagnosis and treatment, improve healthcare quality, and reduce patient LOS, which is the very key to enhancing the AMI treatments in the rural region of Eastern China. Key words: Myocardial infarction; Length of stay; Quality of health care; Hospitals, rural