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Shifting costs. Hospitals may be saving money because coronary artery bypass surgery (CABG) patients are being discharged sooner, but a study by researchers from the Boston University School of Medicine shows that costs are actually being shifted to other health-care providers. Because CABG patients use outpatient nursing services and extended care facilities after being discharged from the hospital, what appear to be cost savings are actually cost shifting.

Harold Lazar, a MED professor of cardiothoracic surgery, and his colleagues looked at data from patients who had undergone CABG surgery in 1990, before protocols to reduce length of stay were in place, and compared the information with that of patients operated on in 1998, when the protocols were used. Despite the fact that the patients in 1998 were sicker and had increased risk factors, they spent less time on ventilators and less time in the hospital -- an average of 3.8 days less than those in 1990. However, a higher percentage of the 1998 patients were discharged to extended care facilities -- 43 percent, compared with only 3 percent in 1990. Also, patients operated on in 1998 were five times more likely to be readmitted to the hospital.

"While protocols to reduce length of stay have resulted in earlier home discharge for good-risk patients, it has also resulted in an increased utilization of ancillary services and extended care facilities for patients who cannot be discharged home," says Lazar. "Although it is entirely appropriate to utilize extended care facilities for patients who cannot be discharged home in a timely fashion, these facilities may actually consume more health-care resources than in the hospital setting."

The study was published in the April 27 issue of the Journal of Thoracic and Cardiovascular Surgery.

Muscling in on asthma. The prevalence of asthma has been increasing in the United States since the early 1980s, afflicting 14.6 million people in 1994 and more than 17 million people in 1998. In 1994 alone, the cost of treating this chronic lung disease was estimated at .7 billion. Besides AIDS and tuberculosis, asthma is the only chronic disease with an increasing death rate -- every day 14 Americans die from it. Characterized by inflammation of the air passages and temporary narrowing of the airways that transport air to the lungs, asthma is increasingly common in children.

College of Engineering Biomedical Engineering Professor Kenneth Lutchen and graduate student Andrew Jensen (ENG'01) have been working to determine if asthma stems from a defect in the function of the smooth muscle of the airway. They developed a method to monitor in real time the action of the airway muscles while the patients, both healthy and asthmatic, are breathing. They found that the smooth muscles in the airways of asthmatics are different from those in healthy individuals, constricting with greater force and becoming stiffer when constricted, which prevents the airway from reopening during a deep breath. Lutchen and his colleagues are now investigating the factors that create the stiffness in the airway muscle. They suspect that it may be related to increased thickness of the muscle and decreased periodic stretching.

Their research was reported in the Journal of Applied Physiology, and will be featured as a Highlighted Topics Selected Contribution in the July issue.

"Research Briefs" is written by Joan Schwartz in the Office of the Provost. To read more about BU research, visit


15 May 2003
Boston University
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