{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T07:18:23Z","timestamp":1787815103348,"version":"build-2784847793"},"reference-count":22,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Hospital readmissions and excess inpatient length of stay remain important clinical and organisational concerns in cardiovascular care. Although discharge destination has been linked to postacute utilisation and spending, less is known about whether discharge destination is associated with inpatient days exceeding diagnosis\u2010related expected stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims and Objectives<\/jats:title>\n                    <jats:p>This study examined whether discharge destination was associated with excess length of stay above diagnosis\u2010related expected stay among heart failure\u2010related admissions and whether those additional inpatient days were associated with lower 30\u2010day readmission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We conducted a retrospective observational study of administrative admissions recorded between August 2016 and October 2017 at a large academic urban teaching hospital. The primary outcome was excess length of stay, defined as max (length of stay\u2014CMS geometric mean length of stay, 0). The primary explanatory variable was discharge destination, grouped as home, skilled nursing, other facility or discontinued care. Multivariable regression models estimated adjusted associations with excess length of stay, and a secondary generalised estimating equation model assessed 30\u2010day readmission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The final analytic sample included 1076 admissions from 743 unique patients. Mean excess length of stay was 2.47 days, and 24.3% of admissions were followed by a 30\u2010day readmission. In adjusted models, discharge to skilled nursing was associated with 1.46 additional excess days versus home discharge (95% CI: 0.68\u20132.23;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), while discharge to other facility settings was associated with 1.67 additional excess days (95% CI: 0.29\u20133.04;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.017). Findings were directionally similar in sensitivity analyses. Excess stay was not associated with lower 30\u2010day readmission, and nonhome discharge categories were not associated with lower readmission odds.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this single\u2010site observational sample, nonhome discharge, especially skilled nursing placement, was associated with longer stays above DRG\u2010benchmarked expectations without lower short\u2010term readmission. These findings may reflect greater discharge complexity and local postacute transition constraints, although the study did not directly measure the mechanisms underlying prolonged hospitalisation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jep.70563","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T18:28:12Z","timestamp":1787250492000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Discharge Destination and Excess Length of Stay in Heart Failure\u2010Related Admissions: A Retrospective Single\u2010Centre Study"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3570-0790","authenticated-orcid":false,"given":"Deepti","family":"Singh","sequence":"first","affiliation":[{"name":"Information Systems Department, College of Business California State University Long Beach Long Beach California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9319-3865","authenticated-orcid":false,"given":"Kellas","family":"Cameron","sequence":"additional","affiliation":[{"name":"School of Information Systems, Muma College of Business University of South Florida Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"Centers for Medicare & Medicaid Services \u201cHospital Readmissions Reduction Program (HRRP) \u201d2026 https:\/\/www.cms.gov\/medicare\/payment\/prospective-payment-systems\/acute-inpatient-pps\/hospital-readmissions-reduction-program-hrrp."},{"key":"e_1_2_11_3_1","unstructured":"Centers for Medicare & Medicaid Services \u201cThe Skilled Nursing Facility Value\u2010Based Purchasing (SNF VBP) Program \u201d2026 https:\/\/www.cms.gov\/medicare\/quality\/nursing-home-improvement\/value-based-purchasing."},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2025.7422"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.17.1822"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2004.52202.x"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-044291"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afab035"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-021-07206-5"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.7998"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-025-12494-2"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-022-07937-z"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2024.240167R1"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-025-04700-0"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.41272"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.41281"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2025.09.020"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare13020143"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare13030312"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare13172102"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2019.0766"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.5114\/aoms.2019.89702"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.5603\/CJ.a2016.0005"}],"container-title":["Journal 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