Lower death rate in Oregon hospitals linked to better care

Study raises the possibility of improved hospital care for heart failure in Oregon

Portland, Ore.-- A study by two Oregon Health Sciences University researchers finds that the recent decrease in hospital mortality rates for Oregon heart failure patients is likely due to improved care. The study is published in the September issue of the American Journal of Managed Care.

Mortality reports, indicating the rates and causes of deaths in hospitals, have shown a decline in heart failure deaths nationwide since the early 1990s. Heart failure is the leading cause of hospitalization of people over age 65. OHSU epidemiologist Hanyu Ni, Ph.D., and cardiologist Ray Hershberger, M.D., analyzed the Oregon hospital discharge data 1991 to 1995 and found improved quality of care to be the possible major factor.

"Heart failure care has improved over the last decade and more people are living with heart failure than before," said Ni. "While there is no hard data to show why hospital care may have improved, this study eliminated other variables that could have attributed to declining mortality rates."

During this same time period, other trends have also been noted, such as decreasing length of hospital stays and increasing hospital discharges to skilled nursing facilities. Ni says she took both factors into account when looking at the lower mortality rates and found those factors to be negligible.

"At the same time that lengths of stay and other costs of hospitalization have gone down, the quality of care has increased," said Ni. She noted that since the late 1980s, there has been increased acceptance of the use of ACE inhibitors on heart failure patients, a shift in focus of care to outpatient management and new guidelines on heart failure care from various medical bodies.

"We cannot pinpoint exactly why patient care is better, but we can conclude that patients entering Oregon hospitals for heart failure can expect to be better treated for their condition than a decade ago," said Ni. This is the first study to pinpoint quality of care as the major factor in declining mortality rates.

The study was conducted as part of the Oregon Heart Failure Project, initiated by Hershberger in 1996 at OHSU. Data on hospital mortality rates were obtained from the Oregon Association of Hospitals and Health Systems.