Background: China is experiencing increasing burden of acute myocardial infarction (AMI) in the face of limited\nmedical resources. Hospital length of stay (LOS) is an important indicator of resource utilization.\nMethods: We used data from the Retrospective AMI Study within the China Patient-centered Evaluative Assessment\nof Cardiac Events, a nationally representative sample of patients hospitalized for AMI during 2001, 2006, and 2011.\nHospital-level variation in risk-standardized LOS (RS-LOS) for AMI, accounting for differences in case mix and year,\nwas examined with two-level generalized linear mixed models. A generalized estimating equation model was used\nto evaluate hospital characteristics associated with LOS. Absolute differences in RS-LOS and 95% confidence\nintervals were reported.\nResults: The weighted median and mean LOS were 13 and 14.6 days, respectively, in 2001 (n = 1,901), 11 and\n12.6 days in 2006 (n = 3,553), and 11 and 11.9 days in 2011 (n = 7,252). There was substantial hospital level\nvariation in RS-LOS across the 160 hospitals, ranging from 9.2 to 18.1 days. Hospitals in the Central regions had on\naverage 1.6 days (p = 0.02) shorter RS-LOS than those in the Eastern regions. All other hospital characteristics\nrelating to capacity for AMI treatment were not associated with LOS.\nConclusions: Despite a marked decline over the past decade, the mean LOS for AMI in China in 2011 remained\nlong compared with international standards. Inter-hospital variation is substantial even after adjusting for case mix.\nFurther improvement of AMI care in Chinese hospitals is critical to further shorten LOS and reduce unnecessary\nhospital variation.
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