191384 Resource use and outcomes for heart failure patients: A multicenter study of alternative perspectives

Monday, October 27, 2008: 4:35 PM

Michael K. Ong, MD PhD , Division of General Internal Medicine & Health Services Research, University of California, Los Angeles, Los Angeles, CA
  
Recent national and California studies have documented variation in hospital resource utilization among elderly Medicare beneficiaries with chronic illnesses in their last six months of life. However, this approach makes it impossible to test relationships between utilization and outcomes, because all patients died within six months. We assessed variation in six-month resource use for patients hospitalized with heart failure (HF) at six California academic medical centers using two alternative approaches: “looking forward” for all patients, irrespective of their outcome, and “looking back” from death for expired patients.

Resource utilization variation patterns are similar when assessing individuals who have expired or survived, or when assessing only expired individuals in the last six months of life. However, focusing on expired individuals may overlook associations between greater resource utilization and lower mortality.

Potential interventions to reduce resource utilization variation should be based on approaches that examine all individuals and health outcomes.

Learning Objectives:
Attendees will list the differences between the "Looking Back" methodology and the "Looking Forward" methodology for evaluating the relationship between hospital resource use and outcomes of care Describe the kinds of conclusions that can be drawn from each approach.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been a Principal Investigator on the project being discussed in my presentation.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Update on Health Services Research: Looking Forward, Looking Back
See more of: Medical Care