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Regional variation in hospitalisation and mortality in heart failure: comparison of England and Lombardy using multistate modelling

Alex Bottle (), Chiara Maria Ventura, Kumar Dharmarajan, Paul Aylin, Francesca Ieva and Anna Maria Paganoni
Additional contact information
Alex Bottle: Dr Foster Unit at Imperial College London
Chiara Maria Ventura: MOX - Modelling and Scientific Computing, Dipartimento di Matematica, Politecnico di Milano
Kumar Dharmarajan: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine
Paul Aylin: Dr Foster Unit at Imperial College London
Francesca Ieva: Università degli Studi di Milano
Anna Maria Paganoni: MOX - Modelling and Scientific Computing, Dipartimento di Matematica, Politecnico di Milano

Health Care Management Science, 2018, vol. 21, issue 2, No 11, 292-304

Abstract: Abstract Heart failure (HF) is a common, serious chronic condition with high morbidity, hospitalisation and mortality. The healthcare systems of England and the northern Italian region of Lombardy share important similarities and have comprehensive hospital administrative databases linked to the death register. We used them to compare admission for HF and mortality for patients between 2006 and 2012 (n = 37,185 for Lombardy, 234,719 for England) with multistate models. Despite close similarities in age, sex and common comorbidities of the two sets of patients, in Lombardy, HF admissions were longer and more frequent per patient than in England, but short- and medium-term mortality was much lower. English patients had more very short stays, but their very elderly also had longer stays than their Lombardy counterparts. Using a three-state model, the predicted total time spent in hospital showed large differences between the countries: women in England spent an average of 24 days if aged 65 at first admission and 19 days if aged 85; in Lombardy these figures were 68 and 27 days respectively. Eight-state models suggested disease progression that appeared similar in each country. Differences by region within England were modest, with London patients spending more time in hospital and having lower mortality than the rest of England. Whilst clinical practice differences plausibly explain these patterns, we cannot confidently disentangle the impact of alternatives such as coding, casemix, and the availability and use of non-hospital settings. We need to better understand the links between rehospitalisation frequency and mortality.

Keywords: Heart failure; Administrative data; Multistate models; International comparison; Mortality; Readmission (search for similar items in EconPapers)
Date: 2018
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DOI: 10.1007/s10729-017-9410-x

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