Comparison of Maternal and Neonatal Subspecialty Care Provision by Hospital

2021 ◽  
Author(s):  
Mark A. Clapp ◽  
Sindhu K. Srinivas ◽  
Katy B. Kozhimannil ◽  
William A. Grobman ◽  
Anjali J. Kaimal
Keyword(s):  
High Risk ◽  
Maternal Care ◽  
Placenta Previa ◽  
Neonatal Care ◽  
American Hospital ◽  
American Hospital Association ◽  
Annual Survey ◽  
Key Points ◽  
Using Data ◽  
The Relationship

Objective The aim of the study is to determine the relationship between a hospital's provision of subspecialty neonatal and maternal care. Specifically, we sought to understand where women with high-risk maternal conditions received intrapartum care and estimate the potential transfer burden for those with maternal high-risk conditions delivering at hospitals without subspecialty maternal care. Study Design This is a descriptive study using data from 2015 State Inpatient Databases and the American Hospital Association Annual Survey. Characteristics were compared between hospitals based on the concordance of their maternal and neonatal care. The incidences of high-risk maternal conditions (pre-eclampsia with severe features, placenta previa with prior cesarean delivery, cardiac disease, pulmonary edema, and acute liver failure) were compared. To determine the potential referral burden, the percent of women with high-risk conditions delivering at a hospital without subspecialty maternal care but delivering in a county with a hospital with subspecialty maternal care was calculated. Results The analysis included 486,398 women who delivered at 544 hospitals, of which 104 (19%) and 182 (33%) had subspecialty maternal and neonatal care, respectively. Ninety-eight hospitals provided both subspecialty maternal and neonatal care; however, 84 hospitals provided only subspecialty neonatal care but no subspecialty maternal care. Among high-risk maternal conditions examined, approximately 65% of women delivered at a hospital with subspecialty maternal care. Of the remainder who delivered at a hospital without subspecialty maternal care, one-third were in a county where subspecialty care was present. For women with high-risk conditions who delivered in a county without subspecialty maternal care, the median distance to the closest county with subspecialty care was 52.8 miles (IQR 34.3–87.7 miles). Conclusion Approximately 50% of hospitals with subspecialty neonatal care do not provide subspecialty maternal care. This discordance may present a challenge when both high-risk maternal and neonatal conditions are present. Key Points

The Relationship between Hospital Characteristics and the Cost of Hospital Care

2000 ◽  
Vol 13 (4) ◽  
pp. 256-263 ◽  
Author(s):  
Patrick Asubonteng Rivers ◽  
Sejong Bae
Keyword(s):  
Hospital Care ◽  
American Hospital ◽  
American Hospital Association ◽  
Annual Survey ◽  
Hospital Executives ◽  
The Cost ◽  
The Relationship ◽  
Hospital Characteristics

This article examines the relationship between hospital characteristics and costs of hospital care, using the 1991 American Hospital Association Annual Survey of Hospitals. The results discussed herein have implications for hospital executives, researchers and policymakers.

Hospital Religious Affiliation and Outcomes for High-Risk Infants

2011 ◽  
Vol 69 (3) ◽  
pp. 316-338 ◽  
Author(s):  
Melissa M. Garrido ◽  
Kirk C. Allison ◽  
Mark J. Bergeron ◽  
Bryan Dowd
Keyword(s):  
Health Care ◽  
Religious Affiliation ◽  
Perinatal Outcomes ◽  
Extremely Low Birth Weight ◽  
American Hospital ◽  
American Hospital Association ◽  
For Profit ◽  
Annual Survey ◽  
Not For Profit ◽  
Organizational Affiliation

The effect of hospital organizational affiliation on perinatal outcomes is unknown. Using the 2004 American Hospital Association Annual Survey and Healthcare Cost and Utilization Project State Inpatient Databases, the authors examined relationships among organizational affiliation, equipment and service availability and provision, and in-hospital mortality for 5,133 infants across five states born with very low and extremely low birth weight and congenital anomalies. In adjusted bivariate probit selection models, the authors found that government hospitals had significantly higher mortality rates than not-for-profit nonreligious hospitals. Mortality differences among other types of affiliation (Catholic, not-for-profit religious, not-for-profit nonreligious, and for-profit) were not statistically significant. This is encouraging as health care reform efforts call for providers at facilities with different institutional values to coordinate care across facilities. Although there are anecdotes of facility religious affiliation being related to health care decisions, the authors did not find evidence of these relationships in their data.

Accountable care organizations: a strategy for future success?

2018 ◽  
Vol 21 (2) ◽  
pp. 113-121
Author(s):  
Jeffrey Harrison ◽  
Aaron Spaulding ◽  
Debra A. Harrison
Keyword(s):  
Community Dynamics ◽  
Accountable Care Organizations ◽  
Accountable Care ◽  
Healthcare Organizations ◽  
American Hospital ◽  
American Hospital Association ◽  
Content Type ◽  
For Profit ◽  
Annual Survey ◽  
Final Rule

Purpose The purpose of this paper is to assess the community dynamics and organizational characteristics of US hospitals that participate in accountable care organizations (ACO). Design/methodology/approach Data were obtained from the 2015 American Hospital Association annual survey and the 2015 medicare final rule standardizing file. The study evaluated 785 hospitals which operate ACO in contrast to 1,446 hospitals without an ACO. Findings In total, 89 percent of hospitals using ACO’s are located in urban communities and 87 percent are not-for-profit. Hospitals with a higher case mix index are more likely to have an ACO. Practical implications ACOs allow healthcare organizations to expand their geographic markets, achieve greater efficiencies, and enhance the development of new clinical services. They also shift the focus of care from acute care hospitalization to the full continuum of care. Originality/value This research found ACOs with hospital and physician networks are an effective mechanism to control healthcare costs and reduce medical errors.

Abstract 20172: Identifying Hospital Cardiac Services for Acute Myocardial Infarction Using Individual Patient Claims Data

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Tiffany E Chang ◽  
Shu-Xia Li ◽  
Isuru Ranasinghe ◽  
Harlan Krumholz
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Claims Data ◽  
Administrative Claims ◽  
Hospital Data ◽  
American Hospital ◽  
American Hospital Association ◽  
Surgical Services ◽  
Chest X Ray ◽  
Using Data

Background: Hospital data on cardiac services provided is restricted to a limited number of services collected by the American Hospital Association (AHA) Survey. We developed an alternative method to identify hospital services using individual patient administrative claims data for acute myocardial infarction (AMI) in the Premier Database. Methods: We first determined inpatient cardiac services relevant for AMI care from guidelines. Then, we identified these services from patient claims using ICD-9, CPT, Medicare Revenue and provider specialty codes. Additionally, Premier Chargemaster and Physician Specialty Codes were used. A hospital was classified as providing a service if they had >5 AMI patient claims for the service in the Premier database from 2009-2011. To measure the accuracy of the claims based method, we compared the percentage of hospitals that were shown to provide a service identified through the AHA survey for a subset of services identifiable from both sources. Results: We identified 32 services relevant for AMI care that could be defined using data with inpatient claims among 476 hospitals in the Premier database (Figure). The availability of these services ranged from 100% (for services such as chest x-ray) to 1% for heart transplant service. When compared to the subset of 12 services also collected in the AHA survey, a high percentage of agreement (≥80%) was noted for 10/16 (63%) services (such as a dedicated ED, general CT, coronary angiography, PCI, ICU, pharmacist and physio/OT services). Moderate agreement was seen for one service (coronary care unit), and 5/16 (31%) services showed low agreement (≤50%) (EP testing, inpatient cardiac surgical services, inpatient cardiac rehabilitation, transplant unit, and social worker). Conclusion: It is feasible to use claims data to determine in-hospital AMI services, but the accuracy of the method needs to be investigated further for certain services that have a low degree of agreement in our analysis.

scholarly journals Polypharmacy in Older Adults Hospitalized for Heart Failure

2020 ◽  
Vol 13 (11) ◽  
Author(s):  
Ozan Unlu ◽  
Emily B. Levitan ◽  
Evgeniya Reshetnyak ◽  
Jerard Kneifati-Hayek ◽  
Ivan Diaz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Older Adults ◽  
Racial Differences ◽  
The United States ◽  
Negative Effects ◽  
Real World Data ◽  
American Hospital ◽  
American Hospital Association ◽  
Annual Survey ◽  
Regards Study

Background: Despite potential harm that can result from polypharmacy, real-world data on polypharmacy in the setting of heart failure (HF) are limited. We sought to address this knowledge gap by studying older adults hospitalized for HF derived from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). Methods: We examined 558 older adults aged ≥65 years with adjudicated HF hospitalizations from 380 hospitals across the United States. We collected and examined data from the REGARDS baseline assessment, medical charts from HF-adjudicated hospitalizations, the American Hospital Association annual survey database, and Medicare’s Hospital Compare website. We counted the number of medications taken at hospital admission and discharge; and classified each medication as HF-related, non-HF cardiovascular-related, or noncardiovascular-related. Results: The vast majority of participants (84% at admission and 95% at discharge) took ≥5 medications; and 42% at admission and 55% at discharge took ≥10 medications. The prevalence of taking ≥10 medications (polypharmacy) increased over the study period. As the number of total medications increased, the number of noncardiovascular medications increased more rapidly than the number of HF-related or non-HF cardiovascular medications. Conclusions: Defining polypharmacy as taking ≥10 medications might be more ideal in the HF population as most patients already take ≥5 medications. Polypharmacy is common both at admission and hospital discharge, and its prevalence is rising over time. The majority of medications taken by older adults with HF are noncardiovascular medications. There is a need to develop strategies that can mitigate the negative effects of polypharmacy among older adults with HF.

Abstract WP318: Mortality Among Newly Certified Stroke Centers and Other Hospitals in the U.S.

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Shumei Man ◽  
Jesse D Schold ◽  
Ken Uchino
Keyword(s):  
Metastatic Cancer ◽  
Stroke Care ◽  
Prior History ◽  
Medicare Beneficiaries ◽  
American Hospital ◽  
American Hospital Association ◽  
Annual Survey ◽  
Primary Stroke Center ◽  
Short Term Mortality ◽  
Stroke Center

Introduction: Primary Stroke Center (PSC) certification was established to improve stroke care. The numbers of PSCs have significantly increased in the past decade. However, it remains unclear whether PSC certification has any impact on stroke mortality. We examined the short term mortality of hospitals that received initial PSC certification between 2009 and 2013 (new PSCs), compared to those received PSC certification before 2009 (existing PSCs) and those never received PSC certification (NSCs). Method: The inclusion criteria was Medicare beneficiaries aged ≥65 years who were hospitalized between January 1, 2009 to December 31, 2013 with a primary discharge diagnosis of ischemic stroke. The patient information were obtained from the Medicare Provider Analysis and Review (MEDPAR) file. The list and characteristics of hospitals were obtained from the American Hospital Association Annual Survey Database. This study included only those general hospitals with emergency departments. All statistical analyses were performed using SAS Version 9.4 software. Results: Among 1165,960 Medicare beneficiaries included in this study, 28.9% were treated at 2640 NSCs, 24.6% were treated at 634 new PSCs, and 46.6% were treated at 785 existing PSCs. Higher percentages of patients at new and existing PSCs had complicated hypertension, myocardial infarction, congestive heart failure, atrial fibrillation, prior history of cerebrovascular disease, any malignancy, metastatic cancer, peripheral artery disease and smoking (p<0.0001). New PSCs had the lowest unadjusted in-hospital all-cause mortality, followed by NSCs and existing PSCs (4.2%, 4.6% and 5% respectively). Both New and existing PSC groups had lower unadjusted 30 day compared to NSCs (12.5%, 13.2% and 13.7%). New PSCs had lower unadjusted and adjusted 30 day mortality than existing PSCs (Hazard Ratio 0.981, 95% Confidence Interval (0.968, 0.993)). Conclusion: The PSCs that were newly certified between 2009 and 2013 had lower unadjusted in-hospital and 30 day mortality after stroke than existing PSCs and NSCs. It is important to further understand whether this difference results from change in patient population or quality of care.

Characteristics of US Rural Hospitals by Obstetric Service Availability, 2017

2020 ◽  
Vol 110 (9) ◽  
pp. 1315-1317
Author(s):  
Katy B. Kozhimannil ◽  
Julia D. Interrante ◽  
Mariana S. Tuttle ◽  
Carrie Henning-Smith ◽  
Lindsay Admon
Keyword(s):  
United States ◽  
Obstetric Care ◽  
The United States ◽  
Rural Hospitals ◽  
American Hospital ◽  
American Hospital Association ◽  
For Profit ◽  
Annual Survey ◽  
Obstetric Services ◽  
Delivery Obstetric

Objectives. To describe characteristics of rural hospitals in the United States by whether they provide labor and delivery (obstetric) care for pregnant patients. Methods. We used the 2017 American Hospital Association Annual Survey to identify rural hospitals and describe their characteristics based on the lack or provision of obstetric services. Results. Among the 2019 rural hospitals in the United States, 51% (n = 1032) of rural hospitals did not provide obstetric care. These hospitals were more often located in rural noncore counties (counties with no town of more than 10 000 residents). Rural hospitals without obstetrics also had lower average daily censuses, were more likely to be government owned or for profit compared with nonprofit ownership, and were more likely to not have an emergency department compared with hospitals providing obstetric care (P for all comparisons < .001). Conclusions. Rural US hospitals that do not provide obstetric care are located in more sparsely populated rural locations and are smaller than hospitals providing obstetric care. Public Health Implications. Understanding the characteristics of rural hospitals by lack or provision of obstetric services is important to clinical and policy efforts to ensure safe maternity care for rural residents.

Abstract 115: Resuscitation Preferences of Older Patients Hospitalized with Heart Failure: Temporal Trends and Associations with Patient and Hospital Factors

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Justin S Sadhu ◽  
Eugene M Sadhu ◽  
Paul J Hauptman ◽  
Michael W Rich
Keyword(s):  
Temporal Trends ◽  
Multivariable Analysis ◽  
Do Not Resuscitate ◽  
Patient Centered ◽  
American Hospital ◽  
American Hospital Association ◽  
Annual Survey ◽  
Teaching Status ◽  
Eol Care ◽  
Income Quartile

Background: Preferences regarding end-of-life (EOL) care in patients (pts) with HF may be influenced by personal, cultural, and health system factors. We examined characteristics associated with cardiopulmonary resuscitation preferences among pts hospitalized for HF and explored whether rates of Do Not Resuscitate (DNR) status have changed over time. Methods: Using the California State Inpatient Databases from the Healthcare Cost and Utilization Project and the American Hospital Association Annual Survey Databases, we identified 297,156 pts aged ≥ 60 years hospitalized for HF between 2004 and 2011. The first eligible hospitalization for each patient was selected. DNR status documented within the first 24 hours of admission was assessed. Multivariable logistic regression was used to evaluate associations of DNR status with demographic factors, year of admission, median household income quartile, and hospital teaching status. Results: 39,658 (13.4%) pts had a DNR order. Higher proportions with DNR were found among women than men (15.4% vs. 11.0%, p<.0001) and white pts than non-white pts (16.7% vs. 7.3%). Proportions of pts with DNR increased over the study period for both men and women (from 10.0% to 12.3% and 13.7% to 17.2%, respectively, p<.0001 for trend with time) and in both white pts (15.0% to 19.2%) and non-white pts (6.5% to 7.9%), but more rapidly for white pts (p=.02). In multivariable analysis adjusting for age, gender, race, and year of admission, odds ratios (ORs) for DNR were 1.5 per 5-year increase in age, 1.2 for women vs. men, and 2.0 for white vs. non-white pts. After adding income and hospital teaching status to the model, the respective ORs associated with each incremental increase in income quartile and receiving treatment in a teaching hospital were 1.1 and 1.2 (p<.0001 for both). ORs for age, gender, race, income, and hospital teaching status were essentially unchanged after adjustment for comorbidities. Conclusion: DNR status among pts hospitalized with HF is influenced by age, gender, race, and income in addition to hospital teaching status. The proportions of pts with DNR status have increased, but unequally among demographic subgroups. Continued efforts to understand the factors that influence preferences around resuscitation and EOL care are needed to provide truly patient-centered care.

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.

Examining the Relationship between the Lethality Assessment/Domestic Violence High-risk Team Monitoring (LAP/DVHRT) Program and Prosecution Outcomes

2021 ◽  
pp. 088626052110283
Author(s):  
Kristin L. Anderson ◽  
Hannah Bryan ◽  
Alexis Martinez ◽  
Brandon Huston
Keyword(s):  
Domestic Violence ◽  
High Risk ◽  
Sentence Length ◽  
Exact Matching ◽  
Full Sample ◽  
Lethal Violence ◽  
Using Data ◽  
And Control ◽  
The Relationship ◽  
Sentencing Outcomes

Lethality assessment (LAP) and team monitoring of high-risk offenders (DVHRT) are recent U.S. policy innovations designed to identify domestic violence offenders who are at high risk for perpetrating serious or lethal violence against their intimate partners. One goal of LAP/DVHRT is to increase offenders’ accountability for domestic violence within the legal system. This study examines associations between LAP/DVHRT and prosecution and sentencing outcomes using data on domestic violence offenses ( n = 88) involving 37 offenders monitored by a DVHRT and 51 nonmonitored comparison offenders who were identified as high risk on the LAP. We use logistic and OLS regression to estimate models of six prosecution and sentencing outcomes for the full sample and for a sample matched using the coarsened exact matching technique ( n = 73). Multivariate results indicate that when the treatment and comparison samples are matched and control variables are included in regression models, the LAP/DVHRT program is not associated with prosecution or conviction rates, number of charges, or bail amount. DVHRT monitoring is positively associated with sentence length in multivariate analysis and in models using the matched sample. Findings suggest that the LAP/DVHRT program increases offender accountability in the form of incapacitation at the sentencing stages.

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