Aydede SK, Bazzoli GJ, Loeb J, Braun B; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 1598.
University of Florida, Institute for Child Health Policy, 5700 SW 34th Street, Suite 323, Gainsville, FL 32608-5367 Tel. (352) 265-7220 x86335 Fax
RESEARCH OBJECTIVE: It has long been recognized that some hospitals treat disproportionately larger share of patients with complex conditions. On the other hand, during mid to late 1990s, all hospitals have faced increased pressures to contain expenditures. This study explores patient safety and the quality of inpatient care in hospitals with differing case-mix and financial condition. STUDY DESIGN: Hospitals in 11 geographically dispersed states with mandatory participation in AHRQs HCUP State Inpatient Data (SID) program are grouped into those treating patients with more/less severely ill and those that were financially weak/strong. All-Patient Refined Diagnosis-Related Groups (APR-DRG) software was applied to SID discharge data for severity of illness groupings. Hospitals treating patients more severely ill were defined as those with above average percent of APR-DRG major and extreme cases for at least 5 consecutive years during 1995-2000. Financially weak hospitals are those with a negative 3 year (1993-1995) average operating margin. Seven AHRQ Patient Safety Indicators (PSI) (that involve the largest number of patients who are at risk for adverse outcomes) and 5 AHRQ Inpatient Quality Indicators (IQI) (where majority of hospitals treat a sufficient number of patients) are considered. POPULATION STUDIED: 1363 nonfederal, acute care hospitals. PRINCIPAL FINDINGS: When all hospitals (n=1363) were considered: (1) rates for 4 (two sentinel and two nursing-related) out of 5 PSI were higher; and (2) rates for all 3 in-hospital mortality IQI and one technical complication PSI were lower for hospitals serving more severely ill patients than they are for hospitals serving less severely ill patients in 1996. These results persisted in 2000. When the subgroup of financially strong hospitals (n=610) were considered, quality comparisons across hospitals serving more/less severely ill patients gave the same results as above for both 1996 and 2000. When the focus was on financially weak hospitals (n=753): (1) the same result as above persisted for two sentinel and two nursing-related PSIs both in 1996 and 2000; but (2) rates for 3 IQI and one PSI were not different across hospitals serving more/less severely ill patients in 1996; and (3) rates for 3 IQI and one PSI were lower for hospitals serving more severely ill patients than they were for hospitals serving less severely ill patients in 2000. CONCLUSIONS: Generally, these results suggest that hospitals treating a more severely ill patient mix have better outcomes for selected mortality and technical complication measures when compared to hospitals treating less severely ill patient populations. These findings are consistent with theories of learning by doing, but it is also clear that this does not carry through to all PSIs. Hospital financial distress may erode this advantage, however, especially in the short-run. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Although hospitals that treat a more complex patient mix may be able to overcome the adverse effects of financial distress over time, they may experience detrimental changes in patient outcomes in the short-run. As such, these hospitals may require one-time subsidies or targeted financial assistance in the short-run to help avert unfavorable patient outcomes.
Publication Types:
Keywords:
- Diagnosis-Related Groups
- Financial Management, Hospital
- Hospital Mortality
- Hospitalization
- Hospitals
- Humans
- Inpatients
- Insurance, Hospitalization
- Medicaid
- Medicare
- Patient Discharge
- Quality Indicators, Health Care
- Safety
- United States Agency for Healthcare Research and Quality
- economics
- hsrmtgs
UI: 103624632
From Meeting Abstracts