scholarly journals Comparison of Risk-Standardized Readmission Rates of Surgical Patients at Safety-Net and Non–Safety-Net Hospitals Using Agency for Healthcare Research and Quality and American Hospital Association Data

JAMA Surgery ◽  
2019 ◽  
Vol 154 (5) ◽  
pp. 391 ◽  
Author(s):  
Stephanie D. Talutis ◽  
Qi Chen ◽  
Na Wang ◽  
Amy K. Rosen
Keyword(s):  
Safety Net ◽  
Healthcare Research ◽  
Surgical Patients ◽  
Readmission Rates ◽  
American Hospital ◽  
American Hospital Association ◽  
Association Data

scholarly journals Electronic health record adoption in US hospitals: the emergence of a digital “advanced use” divide

2017 ◽  
Vol 24 (6) ◽  
pp. 1142-1148 ◽  
Author(s):  
Julia Adler-Milstein ◽  
A Jay Holmgren ◽  
Peter Kralovec ◽  
Chantal Worzala ◽  
Talisha Searcy ◽  
...  
Keyword(s):  
Information Technology ◽  
Performance Measurement ◽  
Patient Engagement ◽  
Safety Net ◽  
Hospital Performance ◽  
Critical Access Hospitals ◽  
American Hospital ◽  
American Hospital Association ◽  
Ehr Adoption ◽  
Electronic Health

Abstract Objective While most hospitals have adopted electronic health records (EHRs), we know little about whether hospitals use EHRs in advanced ways that are critical to improving outcomes, and whether hospitals with fewer resources – small, rural, safety-net – are keeping up. Materials and Methods Using 2008–2015 American Hospital Association Information Technology Supplement survey data, we measured “basic” and “comprehensive” EHR adoption among hospitals to provide the latest national numbers. We then used new supplement questions to assess advanced use of EHRs and EHR data for performance measurement and patient engagement functions. To assess a digital “advanced use” divide, we ran logistic regression models to identify hospital characteristics associated with high adoption in each advanced use domain. Results We found that 80.5% of hospitals adopted at least a basic EHR system, a 5.3 percentage point increase from 2014. Only 37.5% of hospitals adopted at least 8 (of 10) EHR data for performance measurement functions, and 41.7% of hospitals adopted at least 8 (of 10) patient engagement functions. Critical access hospitals were less likely to have adopted at least 8 performance measurement functions (odds ratio [OR] = 0.58; P < .001) and at least 8 patient engagement functions (OR = 0.68; P = 0.02). Discussion While the Health Information Technology for Economic and Clinical Health Act resulted in widespread hospital EHR adoption, use of advanced EHR functions lags and a digital divide appears to be emerging, with critical-access hospitals in particular lagging behind. This is concerning, because EHR-enabled performance measurement and patient engagement are key contributors to improving hospital performance. Conclusion Hospital EHR adoption is widespread and many hospitals are using EHRs to support performance measurement and patient engagement. However, this is not happening across all hospitals.

scholarly journals Reduction in Hospitals’ Readmission Rates: Role of Hospital-Based Skilled Nursing Facilities

2019 ◽  
Vol 56 ◽  
pp. 004695801881799
Author(s):  
Shivani Gupta ◽  
Ferhat D. Zengul ◽  
Ganisher K. Davlyatov ◽  
Robert Weech-Maldonado
Keyword(s):  
Hospital Readmission ◽  
Fixed Effects ◽  
Skilled Nursing Facility ◽  
Health Resources ◽  
Estimating Equation ◽  
Readmission Rates ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
American Hospital ◽  
American Hospital Association

Hospital readmission within 30 days of discharge is an important quality measure given that it represents a potentially preventable adverse outcome. Approximately, 20% of Medicare beneficiaries are readmitted within 30 days of discharge. Many strategies such as the hospital readmission reduction program have been proposed and implemented to reduce readmission rates. Prior research has shown that coordination of care could play a significant role in lowering readmissions. Although having a hospital-based skilled nursing facility (HBSNF) in a hospital could help in improving care for patients needing short-term skilled nursing or rehabilitation services, little is known about HBSNFs’ association with hospitals’ readmission rates. This study seeks to examine the association between HBSNFs and hospitals’ readmission rates. Data sources included 2007-2012 American Hospital Association Annual Survey, Area Health Resources Files, the Centers for Medicare and Medicaid Services (CMS) Medicare cost reports, and CMS Hospital Compare. The dependent variables were 30-day risk-adjusted readmission rates for acute myocardial infarction (AMI), congestive heart failure, and pneumonia. The independent variable was the presence of HBSNF in a hospital (1 = yes, 0 = no). Control variables included organizational and market factors that could affect hospitals’ readmission rates. Data were analyzed using generalized estimating equation (GEE) models with state and year fixed effects and standard errors corrected for clustering of hospitals over time. Propensity score weights were used to control for potential selection bias of hospitals having a skilled nursing facility (SNF). GEE models showed that the presence of HBSNFs was associated with lower readmission rates for AMI and pneumonia. Moreover, higher SNFs to hospitals ratio in the county were associated with lower readmission rates. These findings can inform policy makers and hospital administrators in evaluating HBSNFs as a potential strategy to lower hospitals’ readmission rates.

Inequality Set in Concrete: Physical Resources Available for Care at Hospitals Serving People of Color and Other U.S. Hospitals

2020 ◽  
Vol 50 (4) ◽  
pp. 363-370 ◽  
Author(s):  
Gracie Himmelstein ◽  
Kathryn E. W. Himmelstein
Keyword(s):  
United States ◽  
The United States ◽  
People Of Color ◽  
American Hospital ◽  
American Hospital Association ◽  
Capital Assets ◽  
Physical Assets ◽  
Association Data ◽  
Hispanic Serving ◽  
Capital Intensive

Racial inequities in health outcomes are widely acknowledged. This study seeks to determine whether hospitals serving people of color in the United States have lesser physical assets than other hospitals. With data on 4,476 Medicare-participating hospitals in the United States, we defined those in the top decile of the share of black and Hispanic Medicare inpatients as “black-serving” and “Hispanic-serving,” respectively. Using 2017 Medicare cost reports and American Hospital Association data, we compared the capital assets (value of land, buildings, and equipment), as well as the availability of capital-intensive services at these and other hospitals, adjusted for other hospital characteristics. Hospitals serving people of color had lower capital assets: for example, US$5,197/patient-day (all dollar amounts in U.S. dollars) at black-serving hospitals, $5,763 at Hispanic-serving hospitals, and $8,325 at other hospitals ( P < .0001 for both comparisons). New asset purchases between 2013 and 2017 averaged $1,242, $1,738, and $3,092/patient-day at black-serving, Hispanic-serving, and other hospitals, respectively ( P < .0001). In adjusted models, hospitals serving people of color had lower capital assets (−$215,121/bed, P < .0001) and recent purchases (−$83,608/bed, P < .0001). They were also less likely to offer 19 of 27 specific capital-intensive services. Our results show that hospitals that serve people of color are substantially poorer in assets than other hospitals and suggest that equalizing investments in hospital facilities in the United States might attenuate racial inequities in care.

Who Votes for Medicaid Expansion? Lessons from Maine's 2017 Referendum

2019 ◽  
Vol 44 (4) ◽  
pp. 563-588 ◽  
Author(s):  
David A. Matsa ◽  
Amalia R. Miller
Keyword(s):  
Direct Democracy ◽  
Census Bureau ◽  
Bachelor's Degree ◽  
Medicaid Expansion ◽  
American Hospital ◽  
American Hospital Association ◽  
Self Interest ◽  
Associate's Degree ◽  
Election Results ◽  
Association Data

Abstract Context: In November 2017, Maine became the first state in the nation to vote on a key provision of the Affordable Care Act: the expansion of Medicaid. Methods: This study merged official election results from localities across Maine with Census Bureau and American Hospital Association data to identify characteristics of areas that support Medicaid expansion. Findings: Places with more bachelor's degree holders more often vote in favor, whereas those with more associate's degree graduates tend to vote against. Conditional on education rates, areas with more uninsured individuals who would qualify for expanded coverage tend to vote in favor, while those with more high-income individuals tend to vote against. Also conditional on education rates, greater hospital employment is associated with support for expansion, but the presence of other health professionals, whose incomes might decrease from expansion, is associated with less support. Conclusions: Voting patterns are mostly consistent with economic self-interest, except for the sizable association of bachelor's degree holders with support for Medicaid expansion. Direct democracy can shift Medicaid policy: extrapolating to other states, the model predicts that hypothetical referenda would pass in 5 of the 18 states that had not yet expanded Medicaid at the time of Maine's vote.

scholarly journals Predictors of Clostridium difficile colitis infections in hospitals

2007 ◽  
Vol 136 (7) ◽  
pp. 913-921 ◽  
Author(s):  
R. RICCIARDI ◽  
K. HARRIMAN ◽  
N. N. BAXTER ◽  
L. K. HARTMAN ◽  
R. J. TOWN ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Infection Control ◽  
Urban Areas ◽  
Geographic Location ◽  
Hospital Level ◽  
American Hospital ◽  
American Hospital Association ◽  
Clostridium Difficile Colitis ◽  
Association Data ◽  
Common Infections

SUMMARYHospital-level predictors of high rates of ‘Clostridium difficile-associated disease’ (CDAD) were evaluated in over 2300 hospitals across California, Arizona, and Minnesota. American Hospital Association data were used to determine hospital characteristics associated with high rates of CDAD. Significant correlations were found between hospital rates of CDAD, common infections and other identified pathogens. Hospitals in urban areas had higher average rates of CDAD; yet, irrespective of geographic location, hospital rates of CDAD were associated with other infections. In addition, hospitals with ‘high CDAD’ rates had slower turnover of beds and were more likely to offer transplant services. These results reveal large differences in rates of CDAD across regions. Hospitals with high rates of CDAD have high rates of other common infections, suggesting a need for broad infection control policies.

Abstract 028: Electronic Health Record Meaningful Use Did Not Improve Pay-for-Performance Outcomes

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Michael P Thompson ◽  
Ilana Graetz ◽  
Naleef Fareed ◽  
Gloria J Bazzoli ◽  
Teresa M Waters
Keyword(s):  
Linear Models ◽  
Pay For Performance ◽  
Meaningful Use ◽  
Safety Net ◽  
Performance Outcomes ◽  
American Hospital ◽  
American Hospital Association ◽  
Annual Survey ◽  
Electronic Health ◽  
One Year

Objective: With the goal of improving healthcare quality, Medicare has implemented a series of pay-for-performance initiatives and allocated substantial financial resources to promote meaningful use of electronic health records (EHRs). The purpose of this study was to examine whether hospitals achieving EHR meaningful use improved hospital 30-day risk-standardized mortality (RSMR) and readmission (RSRR) rates used in Medicare pay-for-performance (P4P) initiatives. Methods: We used publically available data on Medicare EHR Incentive Program achievement (2014 to 2015) to categorize hospitals as achieving two years, one year, or no years of stage 2 meaningful use (i.e. comprehensive EHR) from 2014-2015. Using generalized linear models, we compared the change in publically reported 30-day RSMRs and RSRRs for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia (PN) from 2012 to 2016 by years of stage 2 meaningful use. Models were adjusted for hospital teaching status, system affiliation, ownership status, urban/rural location, bed size, and safety-net status obtained from the American Hospital Association Annual Survey and Medicare Impact File (both 2009-2011). Results: From the 4,755 hospitals participating in the Medicare EHR program, 19.8% and 46.0% had two years and one year of stage 2 meaningful use, while 34.2% never achieved stage 2 meaningful use. The Figure shows that from 2012 to 2016 thirty-day mortality for AMI decreased (-1.2% to -1.4%), increased modestly for CHF (+0.5), and increased for PN (+4.1 to +4.6%). All thirty-day readmission rates decreased during this time, with decreases greater in AMI and CHF (both -2.7% to -2.8%) than in PN (-1.3% to -1.4%). We found that there were no significant differences in risk-standardized mortality or readmission rate changes by years of stage 2 meaningful use, even after adjusting for hospital characteristics (all comparisons p>0.05). Conclusions: While RSMRs and RSRRs have changed substantially from 2012 to 2016 for most conditions, changes were similar for hospitals with two years, one year, or no years of stage 2 EHR meaningful use. Our findings suggest that adoption of more comprehensive EHRs did not improve hospital P4P outcomes. Figure. Change in RSMRs and RSRRs rates by years of stage 2 meaningful use.

Financial Performance of Safety-Net Hospitals in a Changing Health Care Environment

1996 ◽  
Vol 9 (3) ◽  
pp. 156-171 ◽  
Author(s):  
K. Gautam ◽  
C. Campbell ◽  
B. Arrington
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Inner City ◽  
Financial Performance ◽  
Safety Net ◽  
Health Care Environment ◽  
Care Environment ◽  
Research Attention ◽  
American Hospital ◽  
American Hospital Association

Safety-net hospitals serving the poor and indigent in inner-cities have received inadequate research attention regarding the determinants of their financial performance in the changing health care environment. We analyze how the 1990–1992 financial performance of 275 such hospitals is related to exogenous and endogenous factors such as payer mix, service mix, staffing and ownership. Models of hospital financial performance are developed using operating margin, cost per discharge and revenue per discharge as measures of performance. Stepwise regression is used to test the model with data from the American Hospital Association (AHA) and Health Care Investment Analysts (HCIA). Results suggest that: 1) The profitability of inner-city hospitals appears positively related with technical complexity of care; 2) High interest and low operating surplus may constrain the addition of technically sophisticated services to enhance profitability; 3) There is some evidence that new governmental programs, e.g. Medicaid managed care and Medicaid Diagnosis Related Groups (DRGs), may not have improved operating margins, though Medicaid DRGs appear to have contained costs. Follow-up research is needed on this issue; 4) Given external fiscal realities, internal management strategies for inner-city hospitals require research, e.g. developing appropriate managed care systems and timely expansion of sub-acute services and; 5) Services such as AIDS treatment and community health education represent opportunities to respond to community needs, especially since unit cost of such services will decline with high volume.

Abstract P268: Hospital Transfer of Ischemic Stroke Patients: Prevalence and Outcomes

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Amresh D Hanchate ◽  
Lee H Schwamm ◽  
Elaine M Hylek
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Safety Net ◽  
Outcome Evaluation ◽  
Inpatient Mortality ◽  
American Hospital ◽  
American Hospital Association ◽  
Transfer Rates ◽  
Hospital Transfer ◽  
Transferred Patients

BACKGROUND Little is known about transfers of patients across hospitals; inpatient outcome evaluation (report card) protocols are inconsistent in how transfers are accounted. For patients admitted for ischemic stroke in Massachusetts (MA), we estimated prevalence of transfers across hospitals, over time, and differences in inpatient mortality rates compared to patients not transferred. METHODS Discharge and American Hospital Association data were merged for all hospitalizations (2004-09) for ischemic stroke among adults (N=49,789) in all MA acute care hospitals (N=67). We linked all ischemic stroke hospitalizations with preceding and subsequent hospitalizations to obtain ischemic stroke episodes. A transfer was defined as an episode with >=2 hospitalizations such that discharge date for one coincided with admission date for another. We compared transferred and untransferred patients (episodes) in terms of patient risk factors for stroke, hospital characteristics and year. We also compared risk-adjusted inpatient mortality difference for transferred patients using a logistic regression model adjusting for patient demographics and clinical risk factors. RESULTS We identified 47,212 ischemic stroke episodes, of which 9.5% involved a transfer. This rate did not vary significantly during 2004-09. Blacks had higher transfer rates (13%; p<0.001) than Whites (9.3%) and Hispanics (9.6%). Weekend admission did not increase the risk of transfer. Transferred patients had significantly higher prevalence of risk factors for inpatient mortality: atrial fibrillation, hypertension, diabetes mellitus, heart failure and coronary heart disease. Risk-adjusted inpatient mortality among transferred patients was 26% higher than for untransferred patients (9.7% versus 7.3%; p<0.001). While transfer rates were higher for non-teaching and safety-net hospitals, and for hospitals with smaller general care and ICU bed size, substantial numbers of transfers occurred across all hospital types. CONCLUSIONS 9.5% of patients admitted for ischemic stroke experienced a hospital transfer, and were at higher risk for inpatient mortality. Further study needs to explore causal pathways linking hospital transfers and risk of adverse stroke inpatient outcomes.

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