A Profile of Patient Care and Safety in Hospitals with Differing Case-Mix and Financial Condition

1. 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

2. 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)

3. 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?

4. 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

5. 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

6. Results – Hospital Structure and Organizational Characteristics,1995

7. Results–CHF Mortality RateIQI 16

8. Results–Stroke Mortality Rate IQI 17

9. Results–GI Hemorrhage Mortality RateIQI 18

10. Results–Pneumonia Mortality RateIQI 20

11. Results – Decubitus UlcerPSI 03

12. Results – Infection Due to Medical ErrorPSI 07

13. Results–Post-Operative PE or DVTPSI 12

14. 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)

15. 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

16. 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