{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:38:27Z","timestamp":1784309907774,"version":"3.55.0"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T00:00:00Z","timestamp":1734912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Health Serv."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Clinicians are the conduits of high-quality care delivery. Clinicians have driven advancements in pharmacotherapeutics, devices, and related interventions and improved morbidity and mortality in patients with congestive heart failure over the past decade. Yet, the management of congestive heart failure has become extraordinarily complex and has fueled recommendations from the American Heart Association and the American College of Cardiology to optimize the composition of the care team to reduce the health, economic, and the health system burden of high lengths of stay and hospital charges. Therefore, the purpose of this study was to identify the extent to which specific care team configurations were associated with high length of stay and high-charge hospitalizations of patients with congestive heart failure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study performed a retrospective analysis of data extracted from the electronic health records of 3,099 patients and their hospitalizations from the Arkansas Clinical Data Repository. The data was analyzed using binomial logistic regression in which adjusted odds ratios reflected the association of specific care team configurations (i.e., combination of care roles) with length of stay and hospital charges.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Team configurations that included a nurse practitioner, registered nurse, care manager, and social worker were generally above the median length of stay and median charges when compared to team configurations that did not collectively include all of these roles. Patients with larger configurations (i.e., four or more different care roles) had higher length of stays and charges than smaller configurations (i.e., two to three different care roles). The results also validated the Van Walraven Elixhauser Comorbidity Score by finding that its quartiles were associated with length of stay and charges, an indicator of care demand based on patient morbidity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Cardiologists, alone, cannot shoulder the burden of improving patient outcomes. Care team configuration data within electronic health record systems of hospitals could be an effective method of isolating and tracking high-risk patients. Registered nurses may be particularly effective in advancing real-time risk stratification by applying the Van Walraven Elixhauser Comorbidity Score at the point of care, improving the ability of health systems to match care demand with workforce availability.<\/jats:p><\/jats:sec>","DOI":"10.3389\/frhs.2024.1411409","type":"journal-article","created":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T19:36:39Z","timestamp":1734982599000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["The association of workforce configurations with length of stay and charges in hospitalized patients with congestive heart failure"],"prefix":"10.3389","volume":"4","author":[{"given":"Tremaine B.","family":"Williams","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alisha","family":"Crump","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pearman","family":"Parker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam Y.","family":"Garza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emel","family":"Seker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taren Massey","family":"Swindle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taiquitha","family":"Robins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Price","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin Wayne","family":"Sexton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,12,23]]},"reference":[{"key":"B1","article-title":"CDC FASTSTATS\u2014leading causes of death","year":"2023"},{"key":"B2","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1161\/CIR.0000000000000757","article-title":"American Heart Association Council on epidemiology and prevention statistics committee and stroke statistics subcommittee heart disease and stroke statistics 2020 update: a report from the American Heart Association","volume":"141","author":"Virani","year":"2020","journal-title":"Circulation"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.cardfail.2022.02.010","article-title":"2022 AHA\/ACC\/HFSA guideline for the management of heart failure","volume":"28","year":"2022","journal-title":"J Card Fail"},{"key":"B4","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1097\/HCO.0000000000000855","article-title":"Racial and ethnic disparities in heart failure: current state and future directions","volume":"36","author":"Lewsey","year":"2021","journal-title":"Curr Opin Cardiol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1111\/j.1527-5299.2004.02008.x","article-title":"Differences in hospital length-of-stay, charges, and mortality in congestive heart failure patients","volume":"10","author":"Joshi","year":"2004","journal-title":"Congest Heart Fail"},{"key":"B6","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1007\/s10741-017-9661-0","article-title":"Systematic review of economic burden of heart failure","volume":"23","author":"Shafie","year":"2018","journal-title":"Heart Fail Rev"},{"key":"B7","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1001\/jamacardio.2019.0766.","article-title":"Trends in readmissions and length of stay for patients hospitalized with heart failure in Canada and the United States","volume":"4","author":"Samsky","year":"2019","journal-title":"JAMA Cardiol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"26335565231176168","DOI":"10.1177\/26335565231176168","article-title":"Quantifying care delivery team influences on the hospitalization outcomes of patients with multimorbidity: implications for clinical informatics","volume":"13","author":"Williams","year":"2023","journal-title":"J Multimorb Comorb"},{"key":"B9","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1016\/j.jacc.2012.09.038","article-title":"Rehospitalization for heart failure: problems and perspectives","volume":"61","author":"Gheorghiade","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1016\/j.cardfail.2023.02.011","article-title":"Multidisciplinary care in heart failure services","volume":"29","author":"Sokos","year":"2023","journal-title":"J Card Fail"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e260","DOI":"10.1161\/CIR.0000000000001096","article-title":"Leveraging implementation science for cardiovascular health equity: a scientific statement from the American Heart Association","volume":"146","author":"Moise","year":"2022","journal-title":"Circulation"},{"key":"B12","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1016\/j.jacc.2023.05.050","article-title":"Bridging treatment implementation gaps in patients with heart failure: JACC focus seminar 2\/3","volume":"82","author":"Jalloh","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2443","DOI":"10.1161\/01.cir.102.19.2443","article-title":"Team management of patients with heart failure: a statement for healthcare professionals from the cardiovascular nursing council of the American Heart Association","volume":"102","author":"Grady","year":"2000","journal-title":"Circulation"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e0286363","DOI":"10.1371\/journal.pone.0286363","article-title":"Care delivery team composition effect on hospitalization risk in African Americans with congestive heart failure","volume":"18","author":"Williams","year":"2023","journal-title":"PLoS One"},{"key":"B15","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1001\/archinte.163.3.347","article-title":"Outcomes of chronic heart failure","volume":"163","author":"Benatar","year":"2003","journal-title":"Arch Intern Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e001221","DOI":"10.1136\/openhrt-2019-001221","article-title":"A patient-centred, comprehensive model for the care for heart failure: the 360\u00b0 heart failure centre","volume":"7","author":"Halatchev","year":"2020","journal-title":"Open Heart"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1377\/hlthaff.2019.00014","article-title":"Impact of physicians, nurse practitioners, and physician assistants on utilization and costs for complex patients","volume":"38","author":"Morgan","year":"2019","journal-title":"Health Aff (Millwood)"},{"key":"B18","doi-asserted-by":"publisher","first-page":"31","DOI":"10.3233\/978-1-61499-951-5-31","article-title":"Factors associated with increased adoption of a research data warehouse","volume":"257","author":"Baghal","year":"2019","journal-title":"Stud Health Technol Inform"},{"key":"B19","article-title":"Binomial logistic regression using SPSS statistics. How to perform a binomial logistic regression in SPSS statistics","year":"2023"},{"key":"B20","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1097\/MLR.0b013e31819432e5","article-title":"A modification of the elixhauser comorbidity measures into a point system for hospital death using administrative data","volume":"47","author":"van Walraven","year":"2009","journal-title":"Med Care"},{"key":"B21","doi-asserted-by":"publisher","first-page":"015009","DOI":"10.1161\/JAHA.119.015009","article-title":"Phenotyping heart failure according to the longitudinal ejection fraction change: myocardial strain, predictors, and outcomes","volume":"9","author":"Park","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1810","DOI":"10.1161\/CIR.0b013e31829e8807","article-title":"2013 ACCF\/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology foundation\/American Heart Association task force on practice guidelines","volume":"128","author":"Yancy","year":"2013","journal-title":"Circulation"},{"key":"B23","article-title":"Health price transparency","year":"2023"},{"key":"B24","doi-asserted-by":"publisher","first-page":"193","DOI":"10.4258\/hir.2020.26.3.193","article-title":"Toolkit to compute time-based elixhauser comorbidity indices and extension to common data models","volume":"26","author":"Syed","year":"2020","journal-title":"Healthc Inform Res"},{"key":"B25","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1016\/j.hfc.2015.03.011","article-title":"Assessing the quality and comparative effectiveness of team-based care for heart failure: who, what, where, when, and how","volume":"11","author":"Cooper","year":"2015","journal-title":"Heart Fail Clin"},{"key":"B26","doi-asserted-by":"publisher","first-page":"123","DOI":"10.15420\/cfr.2015.1.2.123","article-title":"The key roles for the nurse in acute heart failure management","volume":"1","author":"Riley","year":"2015","journal-title":"Card Fail Rev"},{"key":"B27","volume-title":"Medicine\u2019s Dilemmas: Infinite Needs Versus Finite Resources","author":"Kissick","year":"1994"},{"key":"B28","volume-title":"Nursing and Midwifery in the History of the World Health Organization 1948\u20132017","year":"2017"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1190","DOI":"10.1056\/NEJM199511023331806","article-title":"A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure","volume":"333","author":"Rich","year":"1995","journal-title":"N Engl J Med"},{"key":"B30","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1097\/00005650-199801000-00004","article-title":"Comorbidity measures for use with administrative data","volume":"36","author":"Elixhauser","year":"1998","journal-title":"Med Care"},{"key":"B31","doi-asserted-by":"publisher","first-page":"e008943","DOI":"10.1161\/CIRCHEARTFAILURE.121.008943","article-title":"Trends in characteristics and outcomes in primary heart failure hospitalizations among older population in the United States, 2004 to 2018","volume":"15","author":"Minhas","year":"2022","journal-title":"Circ Heart Fail"},{"key":"B32","doi-asserted-by":"publisher","first-page":"e16233","DOI":"10.1097\/MD.0000000000016233","article-title":"Multidisciplinary rounds in prevention of 30-day readmissions and decreasing length of stay in heart failure patients: a community hospital based retrospective study","volume":"98","author":"Chava","year":"2019","journal-title":"Medicine (Baltimore)"},{"key":"B33","doi-asserted-by":"publisher","first-page":"810","DOI":"10.1016\/j.jacc.2004.05.055","article-title":"Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials","volume":"44","author":"McAlister","year":"2004","journal-title":"J Am Coll Cardiol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1007\/s11886-023-01907-5","article-title":"Broadening heart failure care beyond cardiology: challenges and successes within the landscape of multidisciplinary heart failure care","volume":"25","author":"Olson","year":"2023","journal-title":"Curr Cardiol Rep"},{"key":"B35","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1089\/heq.2021.0175","article-title":"Design of a novel intervention model to address cardiovascular health disparities in the rural underserved community of phillips county Arkansas","volume":"6","author":"Barnes","year":"2022","journal-title":"Health Equity"},{"key":"B36","doi-asserted-by":"publisher","first-page":"E115","DOI":"10.5888\/pcd12.140564","article-title":"Community engagement in health-related research: a case study of a community-linked research infrastructure, Jefferson county, Arkansas, 2011\u20132013","volume":"12","author":"Stewart","year":"2015","journal-title":"Prev Chronic Dis"},{"key":"B37","article-title":"County Health Rankings & Roadmaps","year":"2021"}],"container-title":["Frontiers in Health Services"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2024.1411409\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T19:36:41Z","timestamp":1734982601000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2024.1411409\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,23]]},"references-count":37,"alternative-id":["10.3389\/frhs.2024.1411409"],"URL":"https:\/\/doi.org\/10.3389\/frhs.2024.1411409","relation":{},"ISSN":["2813-0146"],"issn-type":[{"value":"2813-0146","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,23]]},"article-number":"1411409"}}