The association of workforce configurations with length of stay and charges in hospitalized patients with congestive heart failure
IntroductionClinicians are the conduits of high-quality care delivery. Clinicians have driven advancements in pharmacotherapeutics, devices, and related interventions and improved morbidity and mortality in patients with congestive heart failure over the past decade. Yet, the management of congestiv...
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Frontiers Media S.A.
2024-12-01
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| Series: | Frontiers in Health Services |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/frhs.2024.1411409/full |
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| author | Tremaine B. Williams Alisha Crump Alisha Crump Pearman Parker Maryam Y. Garza Emel Seker Taren Massey Swindle Taiquitha Robins Adrian Price Kevin Wayne Sexton Kevin Wayne Sexton Kevin Wayne Sexton |
| author_facet | Tremaine B. Williams Alisha Crump Alisha Crump Pearman Parker Maryam Y. Garza Emel Seker Taren Massey Swindle Taiquitha Robins Adrian Price Kevin Wayne Sexton Kevin Wayne Sexton Kevin Wayne Sexton |
| author_sort | Tremaine B. Williams |
| collection | DOAJ |
| description | IntroductionClinicians are the conduits of high-quality care delivery. Clinicians have driven advancements in pharmacotherapeutics, devices, and related interventions and improved morbidity and mortality in patients with congestive heart failure over the past decade. Yet, the management of congestive heart failure has become extraordinarily complex and has fueled recommendations from the American Heart Association and the American College of Cardiology to optimize the composition of the care team to reduce the health, economic, and the health system burden of high lengths of stay and hospital charges. Therefore, the purpose of this study was to identify the extent to which specific care team configurations were associated with high length of stay and high-charge hospitalizations of patients with congestive heart failure.MethodsThis study performed a retrospective analysis of data extracted from the electronic health records of 3,099 patients and their hospitalizations from the Arkansas Clinical Data Repository. The data was analyzed using binomial logistic regression in which adjusted odds ratios reflected the association of specific care team configurations (i.e., combination of care roles) with length of stay and hospital charges.ResultsTeam configurations that included a nurse practitioner, registered nurse, care manager, and social worker were generally above the median length of stay and median charges when compared to team configurations that did not collectively include all of these roles. Patients with larger configurations (i.e., four or more different care roles) had higher length of stays and charges than smaller configurations (i.e., two to three different care roles). The results also validated the Van Walraven Elixhauser Comorbidity Score by finding that its quartiles were associated with length of stay and charges, an indicator of care demand based on patient morbidity.ConclusionsCardiologists, alone, cannot shoulder the burden of improving patient outcomes. Care team configuration data within electronic health record systems of hospitals could be an effective method of isolating and tracking high-risk patients. Registered nurses may be particularly effective in advancing real-time risk stratification by applying the Van Walraven Elixhauser Comorbidity Score at the point of care, improving the ability of health systems to match care demand with workforce availability. |
| format | Article |
| id | doaj-art-802b951132f7434e867978d273fbdfda |
| institution | Kabale University |
| issn | 2813-0146 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Health Services |
| spelling | doaj-art-802b951132f7434e867978d273fbdfda2024-12-23T19:36:30ZengFrontiers Media S.A.Frontiers in Health Services2813-01462024-12-01410.3389/frhs.2024.14114091411409The association of workforce configurations with length of stay and charges in hospitalized patients with congestive heart failureTremaine B. Williams0Alisha Crump1Alisha Crump2Pearman Parker3Maryam Y. Garza4Emel Seker5Taren Massey Swindle6Taiquitha Robins7Adrian Price8Kevin Wayne Sexton9Kevin Wayne Sexton10Kevin Wayne Sexton11Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United StatesDepartment of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United StatesDepartment of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR, United StatesCollege of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, United StatesDepartment of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United StatesDepartment of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United StatesDepartment of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United StatesDepartment of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United StatesRisc.ai, Little Rock, AR, United StatesDepartment of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United StatesDepartment of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United StatesDepartment of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, United StatesIntroductionClinicians are the conduits of high-quality care delivery. Clinicians have driven advancements in pharmacotherapeutics, devices, and related interventions and improved morbidity and mortality in patients with congestive heart failure over the past decade. Yet, the management of congestive heart failure has become extraordinarily complex and has fueled recommendations from the American Heart Association and the American College of Cardiology to optimize the composition of the care team to reduce the health, economic, and the health system burden of high lengths of stay and hospital charges. Therefore, the purpose of this study was to identify the extent to which specific care team configurations were associated with high length of stay and high-charge hospitalizations of patients with congestive heart failure.MethodsThis study performed a retrospective analysis of data extracted from the electronic health records of 3,099 patients and their hospitalizations from the Arkansas Clinical Data Repository. The data was analyzed using binomial logistic regression in which adjusted odds ratios reflected the association of specific care team configurations (i.e., combination of care roles) with length of stay and hospital charges.ResultsTeam configurations that included a nurse practitioner, registered nurse, care manager, and social worker were generally above the median length of stay and median charges when compared to team configurations that did not collectively include all of these roles. Patients with larger configurations (i.e., four or more different care roles) had higher length of stays and charges than smaller configurations (i.e., two to three different care roles). The results also validated the Van Walraven Elixhauser Comorbidity Score by finding that its quartiles were associated with length of stay and charges, an indicator of care demand based on patient morbidity.ConclusionsCardiologists, alone, cannot shoulder the burden of improving patient outcomes. Care team configuration data within electronic health record systems of hospitals could be an effective method of isolating and tracking high-risk patients. Registered nurses may be particularly effective in advancing real-time risk stratification by applying the Van Walraven Elixhauser Comorbidity Score at the point of care, improving the ability of health systems to match care demand with workforce availability.https://www.frontiersin.org/articles/10.3389/frhs.2024.1411409/fullcare deliverycare team compositioncongestive heart failureelixhauser indexrisk stratificationelectronic health record |
| spellingShingle | Tremaine B. Williams Alisha Crump Alisha Crump Pearman Parker Maryam Y. Garza Emel Seker Taren Massey Swindle Taiquitha Robins Adrian Price Kevin Wayne Sexton Kevin Wayne Sexton Kevin Wayne Sexton The association of workforce configurations with length of stay and charges in hospitalized patients with congestive heart failure Frontiers in Health Services care delivery care team composition congestive heart failure elixhauser index risk stratification electronic health record |
| title | The association of workforce configurations with length of stay and charges in hospitalized patients with congestive heart failure |
| title_full | The association of workforce configurations with length of stay and charges in hospitalized patients with congestive heart failure |
| title_fullStr | The association of workforce configurations with length of stay and charges in hospitalized patients with congestive heart failure |
| title_full_unstemmed | The association of workforce configurations with length of stay and charges in hospitalized patients with congestive heart failure |
| title_short | The association of workforce configurations with length of stay and charges in hospitalized patients with congestive heart failure |
| title_sort | association of workforce configurations with length of stay and charges in hospitalized patients with congestive heart failure |
| topic | care delivery care team composition congestive heart failure elixhauser index risk stratification electronic health record |
| url | https://www.frontiersin.org/articles/10.3389/frhs.2024.1411409/full |
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