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A Profile of Patient Care and Safety in Hospitals with Differing Case-Mix and Financial Condition. Sema K. Aydede, PhD Institute for Child Health Policy, University of Florida ( for the Research Project Team ) Funded by Agency for Healthcare Research and Quality Grant # R01 HS13094. - PowerPoint PPT Presentation
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A Profile of Patient Care and Safety in Hospitals with Differing Case-Mix and Financial Condition
Sema K. Aydede, PhDInstitute for Child Health Policy, University of
Florida
(for the Research Project Team)
Funded byAgency for Healthcare Research and Quality
Grant # R01 HS13094
Background
Some hospitals treat disproportionately larger share of severely ill patients
Mid to late 1990’s, all hospitals faced increased pressures to contain costs
Medical errors account for 44,000 to 98,000 deaths of hospitalized Americans a year (IOM, 1999)
Research Questions What differences exist in the quality of
inpatient care and safety across hospital groups? financially distressed/serving low severity financially distressed/serving high severity non-distressed/serving low severity non-distressed/serving high severity
What differences exist in the structural and organizational characteristics across these hospital groups?
Methods and Key Variables
Data Sources – AHA, MCR, HCUP(SID) Sample – Nonfederal, acute care general
hospitals in 11 SID states (AZ, CA, CO, FL, IA, MD, MA, NJ, NY, WA and WI)
Treating Severely Ill Patients – Above average APR-DRG major and extreme cases in 1995
Financial Distress – Average negative operating margin, 1993-1995
Methods and Key Variables
Inpatient Quality Indicators (IQI) AMI, CHF, Acute Stroke, GI Hemorrhage,
Pneumonia Patient Safety Indicators (PSI)
Complication of Anesthesia, Death in Low Mortality DRG, Decubitus Ulcer, Infections Due to Medical Error, Post-OP Hemorrhage, Post-OP PE or DVT, Accidental Puncture or Laceration
Adjusted Least Square Means – for each IQI & PSI, 1996-2000 Hospital patient age distribution, gender and race
Results – Hospital Structure and Organizational Characteristics,1995
Distressed Non-Distressed
Low Severity
High Severity
Low Severity
High Severity
Bed Size (mean) 187.32 227.15 164.82 213.36
Publicly Owned (%) 31.43 21.59 10.53 9.02
Major Teaching (%) 8.78 14.02 3.22 3.38
System Member (%) 33.05 39.39 51.80 56.39
Medicaid Payer (%) 23.35 19.59 18.47 12.65
RN FTEs/1000 Case-Mix APDs 2.27 2.18 2.48 2.37
Results–CHF Mortality RateIQI 16
0
0.01
0.02
0.03
0.04
0.05
0.06
0.07
1996 1997 1998 1999 2000
Years
Ra
tes
Distressed/Low-Severity Distressed/High-Severity Non-Distressed/Low-Severity Non-Distressed/High-Severity
Results–Stroke Mortality Rate IQI 17
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14
0.16
1996 1997 1998 1999 2000
Years
Ra
tes
Distressed/Low-Severity Distressed/High-Severity Non-Distressed/Low-Severity Non-Distressed/High-Severity
Results–GI Hemorrhage Mortality RateIQI 18
0
0.005
0.01
0.015
0.02
0.025
0.03
0.035
0.04
0.045
1996 1997 1998 1999 2000
Years
Ra
te
Distressed/Low-Severity Distressed/High-Severity Non-Distressed/Low-Severity Non-Distressed/High-Severity
Results–Pneumonia Mortality Rate IQI 20
0
0.02
0.04
0.06
0.08
0.1
0.12
1996 1997 1998 1999 2000
Years
Ra
te
Distressed/Low-Severity Distressed/High-Severity Non-Distressed/Low-Severity Non-Distressed/High-Severity
Results – Decubitus UlcerPSI 03
0
0.005
0.01
0.015
0.02
0.025
1996 1997 1998 1999 2000
Years
Rat
es
Distressed/Low-Severity Distressed/High-Severity Non-Distressed/Low-Severity Non-Distressed/High-Severity
Results – Infection Due to Medical ErrorPSI 07
0
0.005
0.01
0.015
0.02
0.025
1996 1997 1998 1999 2000
Years
Rates
Distressed/Low -Severity Distressed/High-Severity Non-Distressed/Low -Severity Non-Distressed/High-Severity
Results–Post-Operative PE or DVTPSI 12
0
0.001
0.002
0.003
0.004
0.005
0.006
0.007
0.008
0.009
0.01
1996 1997 1998 1999 2000
Years
Rate
s
Distressed/Low-Severity Distressed/High-Severity Non-Distressed/Low-Severity Non-Distressed/High-Severity
Results No significant differences across hospital
groups IQI – AMI PSI – Sentinel event indicators (Complications
of Anesthesia and Death in Low Mortality DRG)
No clear pattern across hospital groups PSI – Technical complication indicators (Post-
OP Hemorrhage or Hematoma and Accidental Puncture or Laceration)
Summary IQI mortality rates – CHF, Stroke, GI
Hemorrhage & Pneumonia Non-distressed/high severity hospitals
perform better PSI adverse event rates – Decubitus
Ulcer, Infections Due to Medical Error & Post-OP PE or DVT High severity hospitals (non-distressed &
distressed) perform worse
Significance to Policy and Future Research
Learning by doing may overcome adverse effects of financial distress for IQI Future research – examine hospital volume
Significant findings for post-operative medical and nursing related adverse event PSIs Future research – examine the effects of hospital
facility and organizational characteristics; explore ways to better adjust for acuity
Examine rates of change in IQI & PSI over time
