@article{1059b3285f1142cea9190a9e6d0e2ed2,
title = "Weekend hospital admission and discharge for heart failure: Association with quality of care and clinical outcomes",
abstract = "Background: Although hospital admissions during weekends have been associated with worse quality of care and worse outcomes in some but not all medical conditions, the impact of weekend versus weekday admission and discharge for heart failure (HF) has not been well studied. This study investigates the association of (1) weekend compared to weekday HF admissions and discharges with quality of care and (2) weekend versus weekday HF admissions with length of stay (LOS) and mortality in the hospital. Methods: Data were analyzed for 81,810 HF admissions at 241 sites participating in Get With the Guidelines (GWTG)-HF from January 2005 to September 2008. The cohort was stratified by weekend versus weekday admission and discharge. Generalized estimating equations adjusted for patient and hospital characteristics and clustering. Results: Mean age was 72 ± 14 years; left ventricular ejection fraction (LVEF) was 39±17%. Inhospital mortality was 3.0% and median LOS 4 days. Weekend admission was associated with decreased odds of LVEF documentation. Weekend discharge was associated with decreased odds of LVEF documentation and completed discharge instructions. Weekend HF admission compared to weekday admission was associated with slightly higher risk-adjusted odds of longer inhospital LOS (1.03 [1.01-1.05] and increased inhospital mortality (1.13 [1.02-1.27]). Conclusions: Among GWTG-HF hospitals, weekend admission and discharge for HF were associated with similar quality of care in many but not all measures. Risk-adjusted LOS was slightly longer and mortality moderately higher for weekend HF admissions.",
author = "Horwich, {Tamara B.} and Hernandez, {Adrian F.} and Li Liang and Albert, {Nancy M.} and LaBresh, {Kenneth A.} and Yancy, {Clyde W.} and Fonarow, {Gregg C.}",
note = "Funding Information: Get With The Guidelines-Heart Failure (GWTG-HF) is an ongoing voluntary, observational data collection and continuous quality-improvement initiative, as previously described. 14 The GWTG-HF registry enrolls adults hospitalized with an episode of new or worsening HF as the primary reason for admission or with significant HF symptoms that developed during hospitalization in which HF was the primary discharge diagnosis. Participating institutions submit consecutive eligible patients to the GWTG-HF database in compliance with Joint Commission and Centers for Medicare and Medicaid standards. Trained personnel abstract clinical data using standardized definitions; variables collected include demographic and clinical characteristics, medical history, previous treatments, contraindications to evidence-based therapies, and inhospital outcomes. Participating hospitals use the interactive, Internet-based Patient Management Tool (Outcome Sciences, Inc, Cambridge, MA) to submit clinical information regarding inhospital care and outcomes. The Internet-based system performs checks to ensure that the reported data are complete. In addition, data quality is monitored for completeness and accuracy. Only sites and variables with a high degree of completeness are used in analyses. Participating institutions submit the GWTG protocol for review and approval by their institutional review board. Because data were used primarily at the local site for quality improvement, sites were granted a waiver of informed consent under the common rule. The Duke Clinical Research Institute served as the data analysis center and has Institutional Review Board approval for analyzing the aggregate deidentified data for research purposes. Outcome Sciences, Inc, serves as the data collection and coordination center for GWTG. GWTG-HF is a program funded by the American Heart Association and is supported in part by unrestricted educational grants from GlaxoSmithKline and Medtronic. ",
year = "2009",
month = sep,
doi = "10.1016/j.ahj.2009.06.025",
language = "English (US)",
volume = "158",
pages = "451--458",
journal = "American heart journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "3",
}