With the advent of managed care, pressures to reduce inpatient lengths of. stay have intensified. Post-operative length of stay following coronary artery bypass graft surgery (CABG) has declined dramatically in the last five years, with the proportion of patients discharged within five days of surgery exceeding 50% in many hospitals. The impact of shorter CABG stays on patient outcomes is unknown, as previous studies have been limited to observational reports from single institutions. The overall objective of this study is to determine whether hospitals vary in their ability to achieve relatively low CABG post-operative lengths of stay without compromising clinical outcomes. We will also identify patient and hospital factors that are associated with good outcomes following early discharge. Using data from several states, we will address four specific aims as follow: (1) Examine recent trends in the rate of early discharge, both at the state and hospital levels, and assess how these trends vary with state and hospital characteristics; (2) examine the relationship between patient outcomes (death and readmission or death) and the rate of early discharge at the patient and hospital levels, after adjusting for patient risk; and (3) explore factors associated with desirable and undesirable combinations of post-operative length of stay and clinical outcomes and (4) examine the impact of early discharge on downstream costs. Outcomes in high-risk patients, such as the elderly, will be specifically examined. This research will contribute to ongoing efforts to evaluate the impact of changing patterns of care delivery on the quality of care.
