Baker D, Einstadter D, Thomas C, Husak S, Gordon N, Gordon N, Cebul R; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2001; 18: 163.
Center for Health Care Research and Policy, Case Western Reserve University at MetroHealth Medical Center, 2500 MetroHealth Drive, Rammelkamp Room 221, Cleveland, OH 44109-1998, Phone: (216) 778-3904, Fax: (216) 778-3904, E-mail: dwb@po.cwru.edu
RESEARCH OBJECTIVE: The Cleveland Health Quality Choice (CHQC) program was developed to provide information about risk-adjusted in-hospital mortality for 30 hospitals in Northeast Ohio so data on quality could be used for health care decisions. Observed in-hospital mortality declined markedly during the time CHQC was operational (1991-97). However, CHQC did not track patients after discharge, so it is not known whether long-term outcomes improved. This paper examines temporal trends in risk-adjusted in-hospital and 30-day mortality in Northeast Ohio between 1991-97.STUDY DESIGN: We conducted a longitudinal cohort study of Medicare patients hospitalized with 6 conditions. CHQC data files were linked with Medicare Provider Analysis and Review (MEDPAR) files to determine 30-day mortality. To adjust for changes in admission illness severity, we developed models of predicted 30-day mortality using clinical information obtained from chart abstraction.POPULATION STUDIED: Medicare patients age 65 and older discharged from hospitals participating in CHQC after a first admission for acute myocardial infarction (AMI; N=10,439), congestive heart failure (CHF; N=23,505), gastrointestinal hemorrhage (GIH; N=11,088), chronic obstructive pulmonary disease (COPD; N=8495), pneumonia (N=23,719), or stroke (14,293).PRINCIPAL FINDINGS: Admission severity of illness increased significantly between 1991-97 for GIH and pneumonia. Despite flat or increasing admission severity, mean length of stay declined dramatically (AMI, 10.6 to 8.1 days; CHF, 9.2 to 6.6 days; GIH, 8.3 to 6.2 days; COPD, 7.5 to 5.4 days; pneumonia, 10.3 to 7.3 days; and stroke, 10.4 to 6.3 days; p < .001 for all). Crude in-hospital mortality declined for all conditions, and the relative risk reductions were significant for AMI (-20.2%; 95% CI -31.1 to -8.0), CHF (-46.7%; 95% CI -55.4 to -36.2.%), pneumonia (-23.0%; 95% CI -32.1 to -12.9), and COPD (-49.6%; 95% CI -65.4 to -26.8), but not for GI hemorrhage (-19.3%; 95% CI -39.0 to 6.6) or stroke (-4.8%; 95% CI -18.8 to 11.3). However, temporal trends for crude 30-day mortality showed strikingly different trends; the only condition for which there was a statistically significant decline was CHF (-12.4%; 95% CI -23.7 to -0.0%). After adjusting for severity of illness, the temporal trends for in-hospital and 30-day mortality were similar. Risk-adjusted 30-day mortality declined significantly only for CHF (relative decline -15.3%, 95% CI -27.3 to -1.5%) and COPD (relative decline -26.0%, 95% CI -45.2 to -0.7%). For stroke, risk-adjusted 30-day mortality actually increased by 33.8% (95% CI 14.4 to 55.6%).CONCLUSIONS: Despite impressive declines in in-hospital mortality when CHQC was operational, 30-day mortality improved only slightly for 2 of 6 conditions and actually worsened for 1. We find little or no evidence that publicly reporting risk-adjusted in-hospital mortality rates was associated with improved health outcomes.IMPLICATIONS FOR POLICY, DELIVERY, OR PRACTICE: Mortality Trends For Medicare Patients Hospitalized With 6 Medical Conditions During A Program To Publicly Report Hospital Performance.PRIMARY FUNDING SOURCE: This grant was support by grant number R01 HS09969 from the Agency for Healthcare Research and Quality
Publication Types:
Keywords:
- Cohort Studies
- Heart Failure
- Hospital Mortality
- Hospitals
- Humans
- Longitudinal Studies
- Medicare
- Myocardial Infarction
- Ohio
- Patient Discharge
- Pneumonia
- Pulmonary Disease, Chronic Obstructive
- Risk Adjustment
- Stroke
- economics
- methods
- mortality
- organization & administration
- trends
- hsrmtgs
Other ID:
UI: 102273485
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