scholarly journals Severe Vision Impairment and Blindness in Hospitalized Patients: A Nationwide Study

2020 ◽  
Author(s):  
Che Harris ◽  
Scott M Wright
Keyword(s):  
Length Of Stay ◽  
Visual Impairment ◽  
Hospitalized Patients ◽  
Mean Difference ◽  
Vision Impairment ◽  
Hospital Charges ◽  
Total Hospital ◽  
Obesity Epidemic ◽  
Charlson Comorbidity Score ◽  
Attention To Detail

Abstract Background: Outcomes among hospitalized patients with severe vision impairment or blindness have not been extensively explored. This study sought to determine clinical and resource utilization outcomes in patients with severe vision impairment/blindness (SVI/B). Because the obesity epidemic is also on the rise and underrecognized in hospital settings, we also sought to understand its impact among patients with SVI/B.Methods: We conducted a retrospective study using the National Inpatient Sample for the year 2017; hospitalized adults with and without SVI/B were compared. In addition, for all patients with SVI/B, we compared those with and without obesity. Multiple logistic regression and linear analysis were used to evaluate mortality, disposition, length of stay, and hospital charges. We adjusted for age, sex, race, comorbidities, insurance, and income.Results: 30,420,907 adults were hospitalized, of whom 37,200 had SVI/B. Patients with SVI/B were older (mean age ± SEM: 66.4±0.24 vs. 57.9±0.09 years, p <0.01), less likely to be female (50% vs 57.7%, p <0.01), more frequently insured by Medicare (75.7% vs 49.2%, p <0.01), and had more comorbidities (Charlson comorbidity score ≥ 3: 53.2% vs 27.8%, p <0.01). Patients with SVI/B had a higher in-hospital mortality rate (3.9% vs 2.2%; p<0.01), and they were less likely discharged home (adjusted Odds Ratio {aOR} =0.54, [Confidence Interval (CI) 0.51-0.58]; p <0.01) compared to those without visual impairment. Hospital charges were not significantly different (adjusted Mean Difference {aMD} = $247 CI [-$2,474-2,929]; p=0.85) but length of stay was longer (aMD= 0.5 days CI [0.3-0.7]; p<0.01) for those with SVI/B. Visually impaired patients who were also obese had higher total hospital charges compared to those without obesity (mean difference: $9,821 [CI $1,375-$18,268]; p =0.02).Conclusion: Patients admitted to American hospitals in 2017 who had severe vision impairment or blindness had worse clinical outcomes and greater resources utilization. Hospital-based healthcare professionals should recognize that because those with visual impairment are at risk for worse outcomes, extra attention to detail may be warranted to minimize the propagation of such disparity.

scholarly journals Severe vision impairment and blindness in hospitalized patients: a retrospective nationwide study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ché Matthew Harris ◽  
Scott Mitchell Wright
Keyword(s):  
Length Of Stay ◽  
Healthcare Providers ◽  
Hospitalized Patients ◽  
Mean Difference ◽  
Vision Impairment ◽  
Hospital Charges ◽  
Total Hospital ◽  
Charlson Comorbidity Score ◽  
Multiple Variables ◽  
To Receive

Abstract Background Outcomes among hospitalized patients with severe vision impairment or blindness have not been extensively explored. This study sought to determine clinical and resource utilization outcomes in patients with severe vision impairment/blindness (SVI/B). Because obesity is very common among those who are hospitalized, we also sought to understand its impact among patients with SVI/B. Methods We conducted a retrospective study using the National Inpatient Sample for the year 2017; hospitalized adults with and without SVI/B were compared. In addition, for all patients with SVI/B, we compared those with and without obesity. Multiple logistic regression and linear analysis were used to evaluate mortality, disposition, length of stay, and hospital charges; the analyses were adjusted for multiple variables including age, sex, and race. Results 30,420,907 adults were hospitalized, of whom 37,200 had SVI/B. Patients with SVI/B were older (mean age ± SEM: 66.4 ± 0.24 vs. 57.9 ± 0.09 years, p < 0.01), less likely to be female (50 % vs. 57.7 %, p < 0.01), more frequently insured by Medicare (75.7 % vs. 49.2 %, p < 0.01), and had more comorbidities (Charlson comorbidity score ≥ 3: 53.2 % vs. 27.8 %, p < 0.01). Patients with SVI/B had a higher in-hospital mortality rate (3.9 % vs. 2.2 %; p < 0.01), and had lower odds to be discharged home after hospital discharge (adjusted Odds Ratio {aOR} =0.54, [Confidence Interval (CI) 0.51–0.58]; p < 0.01) compared to those without SVI/B. Hospital charges were not significantly different (adjusted Mean Difference {aMD} = $247 CI [-$2,474-2,929]; p = 0.85) but length of stay was longer (aMD = 0.5 days CI [0.3–0.7]; p < 0.01) for those with SVI/B. Patients with vision impariment who were also obese had higher total hospital charges compared to those without obesity (mean difference: $9,821 [CI $1,375-$18,268]; p = 0.02). Conclusions Patients admitted to American hospitals in 2017 who had SVI/B had worse clinical outcomes and greater resources utilization than those without SVI/B. Hospital-based healthcare providers who understand that those with SVI/B may be at risk for worse outcomes may be optimally positioned to help them to receive the best possible care.

scholarly journals Severe Vision Impairment and Blindness in Hospitalized Patients: A Nationwide Study

2020 ◽  
Author(s):  
Che Harris ◽  
Scott M Wright
Keyword(s):  
Length Of Stay ◽  
Nationwide Inpatient Sample ◽  
Hospitalized Patients ◽  
Adverse Outcomes ◽  
Vision Impairment ◽  
Hospital Charges ◽  
Multiple Logistic Regression ◽  
Charlson Comorbidity Score ◽  
Vulnerable Patient ◽  
Vulnerable Patient Population

Abstract Background: Outcomes among hospitalized patients with severe vision impairment or blindness have not been extensively explored. This study sought to determine clinical and resource utilization outcomes in patients with severe vision impairment/blindness (SVI/B).Methods This was a retrospective study using the Nationwide Inpatient Sample for the year 2017, hospitalized adults with and without severe vision impairment/blindness were compared. Multiple logistic regression and linear analysis were used to evaluate mortality, disposition, length of stay, and hospital charges. Results: 30,420,907 adults were hospitalized, and among these 37,200 had SVI/B. Patients with SVI/B were older (mean age ± SEM: 66.4±0.24 vs. 57.9±0.09 years, p <0.01), less likely to be female (50% vs 57.7%, p <0.01), and more frequently insured by Medicare (75.7% vs 49.2%, p <0.01). Patients with SVI/B had more comorbidities (Charlson comorbidity score ≥ 3: 53.2% vs 27.8%, p <0.01). They also had a higher mortality rate (3.9% vs 2.2%; p<0.01). Those with SVI/B were less likely discharged home (adjusted Odds Ratio {aOR} =0.54, [Confidence Interval (CI) 0.51-0.58]; p <0.01). Hospital charges were not significantly different (adjusted Mean Difference {aMD} = $247 CI [-$2,474-2,929]; p=0.85) but length of stay was longer (aMD= 0.5 days CI [0.3-0.7]; p<0.01) for those with SVI/B.Conclusion: Patients admitted to American hospitals in 2017 who had severe vision impairment or blindness had worse clinical and greater resources utilization. Hospital-based providers should recognize this vulnerable patient population as being at risk for adverse outcomes during hospitalization and determine interventional strategies.

scholarly journals Obesity as a Risk Factor Among Hospitalized Patients with Infective Endocarditis

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Ché Matthew Harris ◽  
Aiham Albaeni ◽  
Scott Wright ◽  
Keith C Norris
Keyword(s):  
Regression Analysis ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Multivariate Regression Analysis ◽  
Hospitalized Patients ◽  
Hospital Charges ◽  
Total Hospital ◽  
Charlson Comorbidity Score ◽  
Hospital Resources ◽  
The Impact

Abstract Objective Obesity contributes to diagnostic and management challenges for many hospitalized patients. The impact of obesity on in-hospital outcomes in patients with infective endocarditis has not been studied and was the focus of this investigation. Method We used the 2013 and 2014 Nationwide Inpatient Sample to identify adults ≥18 years of age with a principle diagnosis of endocarditis. We divided the sample into 2 groups based on presence of absence of obesity. Multivariate linear and logistic regression analysis was used to compare in-hospital mortality, valvular replacement, length of stay (LOS), and hospitalization charges. Results A total of 24 494 adults 18 years and older were hospitalized with infective endocarditis, of which 2625 were classified as obese. Patients with obesity were older (mean age, 57.8 ± 0.3 vs 54.3 ± 0.6 years; P &lt; .01), more likely to be female (50.1% vs 36.1%; P &lt; .01), and had more comorbidities (Charlson comorbidity score ≥ 3, 50.6% vs 28.8%; P &lt; .01). Multivariate regression analysis found no differences between the 2 groups for mortality or repairs or replacements for any valve. On evaluation of resource utilization, patients with obesity had longer average LOS (13.9 days; confidence interval [CI], 12.7–15.1 vs 12.4 days; CI, 12.0–12.8; P = .016) and higher total hospital charges (US $160 789.90; CI, $140.922.40–$180 657.50 vs US $130 627.20; CI, $123 916.70–$137 337.70; P &lt;.01). After adjustment for LOS for total hospital charges, there was no observed difference $11436.26 (CI, -$6649.07–$29521.6; P = .22). Conclusions . Obesity does not significantly impact in-hospital mortality or surgical valvular interventions among patients hospitalized with infective endocarditis, but obesity is associated with increased utilization of hospital resources.

Skin, Soft Tissue, Bone, and Joint Infections in Hospitalized Patients: Epidemiology and Microbiological, Clinical, and Economic Outcomes

2007 ◽  
Vol 28 (11) ◽  
pp. 1290-1298 ◽  
Author(s):  
Benjamin A. Lipsky ◽  
John A. Weigelt ◽  
Vikas Gupta ◽  
Aaron Killian ◽  
Michael M. Peng
Keyword(s):  
Soft Tissue ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Large Population ◽  
Hospitalized Patients ◽  
Economic Outcomes ◽  
Clinical Severity ◽  
Hospital Charges ◽  
Healthcare Associated ◽  
Culture Positive

Background.Infections involving skin, soft tissue, bone, or joint (SSTBJ) are common and often require hospitalization. There are currently few published studies on the epidemiology and clinical and economic outcomes of these infections, whether acquired in the community or healthcare setting, in a large population.Objective.To characterize outcomes of culture-proven SSTBJ infection in hospitalized patients, using information from a large database.Design.We identified patients hospitalized in 134 institutions during 2002-2003 for whom specific International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes and a culture-positive SSTBJ specimen were recorded. Patients were classified into 4 clinical groups based on the type and clinical severity of infection. Patients in each group were further classified on the basis of whether their infection was community acquired or healthcare associated and whether it was complicated or uncomplicated.Results.We identified 12,506 patients with culture-positive infections and categorized them as having cellulitis (37.3%), osteomyelitis or septic arthritis (22.4%), surgical wound infection (26.1%), device-associated or prosthesis infection (7.2%), or other SSTBJ infection (6.9%). Monomicrobial infection was reported for 59% of patients, 54.6% of whom had Staphylococcus aureus as the etiologic agent. Of all S. aureus isolates recovered, 1,121 (28.0%) of 4,007 were resistant to methicillin. Healthcare-associated infections accounted for 27.2% of cases and were associated with a significantly greater mortality rate, a longer length of stay, and greater hospital charges, compared with community-acquired infections. Patients with a complicated infection (78.4%) had a significantly greater mortality rate, a longer length of stay, and greater hospital charges, compared with patients with an uncomplicated infection.Conclusions.SSTBJ infections are frequent among hospitalized patients. S. aureus caused infection in more than 50% of the patients studied, and 28.0% of the S. aureus isolates recovered were resistant to methicillin. Healthcare-associated and complicated infections are associated with a significantly higher mortality rate and more prolonged and expensive hospitalizations. These findings could assist in projects to revise current management strategies in order to optimize outcomes while restraining costs.

scholarly journals 394. Impact of Day of Admission and Time to Diagnostic Arthrocentesis on Mortality and Other Outcomes in Solid-Organ Transplant Recipients with Septic Arthritis: A Nationwide Analysis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S202-S202
Author(s):  
Gustavo Contreras Anez ◽  
Ana B Arevalo ◽  
Shane E Murray ◽  
Christian Olivo Freites
Keyword(s):  
Length Of Stay ◽  
Septic Arthritis ◽  
Organ Transplant ◽  
Mortality Rates ◽  
Solid Organ Transplant ◽  
Hospital Charges ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Total Hospital ◽  
Solid Organ Transplant Recipients

Abstract Background Multiple cases have been reported assessing the outcomes for solid-organ transplant recipients (SOTR) admitted to the hospital with septic arthritis of a native joint (SANJ); however, there are no data evaluating the outcome of these patients when they are admitted on the weekend compared with the rest of the week. Methods The NIS database of the year 2016 was utilized to identify all SOTR with SANJ using ICD-10 codes. SOTR status was defined as those adults with a history of a transplanted organ including heart, lungs, a combined heart and lung, liver, kidney, intestine or pancreas. Admissions between midnight Friday and midnight Sunday were classified as weekend admissions. Early arthrocentesis was defined as percutaneous arthrocentesis performed within 24 hours of admission. Odds ratios (OR) were calculated for primary and secondary outcomes including in-hospital mortality rate, rates of diagnostic arthrocentesis and early arthrocentesis, length o¬f stay and total hospital charges. These results were compared after univariable and multivariable logistic regression adjusted for age, gender, race, day of admission, Charlson comorbidity index and median household yearly income in the patient’s zip code. We used STATA-15 for statistical analysis. Results We identified 319 SOTR with SANJ. Compared with SOTR admitted with SANJ on weekdays, those admitted on weekends had increased in-hospital mortality rates (odds ratio[OR] 11; 95% [CI] 1.2–97.9, P < 0.05), but similar, length of stay (P > 0.05) and hospital charges (P > 0.05). However, regardless of the day of admission those who received an early arthrocentesis had a lower length of stay (P < 0.05), and lower total hospital charges (P < 0.05). Conclusion Our study showed that compared with SOTR admitted with SANJ on weekdays, those admitted on weekends had increased mortality rates but similar length of stays and total hospital charges. However, patients who received an early arthrocentesis had a significantly lower length of stay and hospital charges regardless of the day of admission. These results add weight to the hypothesis of negative outcomes in weekend admissions. Moreover, we believe that our findings require further investigation to establish the role of early arthrocentesis in the management of septic arthritis. Disclosures All authors: No reported disclosures.

Abstract 368: Association of Atrial Fibrillation with In-hospital Outcomes in ST-Elevation Myocardial Infarction - A Propensity Matched Study

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Prakash Harikrishnan ◽  
Marjan Mujib ◽  
Tanush Gupta ◽  
Dhaval Kolte ◽  
Chandrasekar Palaniswamy ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Average Length ◽  
St Elevation Myocardial Infarction ◽  
Hospital Charges ◽  
Total Hospital ◽  
Average Length Of Stay ◽  
St Elevation

Background: Atrial fibrillation is a relatively common comorbid condition in patients with coronary artery disease. However, there are limited data on the association of atrial fibrillation (AF) with outcomes in ST-elevation myocardial infarction (STEMI). Methods: We queried the 2003-2011 Nationwide Inpatient Sample databases using the ICD-9 diagnosis codes, to identify all patients > 18 years admitted with a primary diagnosis of STEMI. We studied the association of AF with in-hospital outcomes in these patients both by regression analysis and propensity match to adjust for demographics, hospital characteristics and co-morbidities. Results: Of the total 452,772 (64.5% men) STEMI hospitalizations, AF was documented in 58,273 (12.9%) cases. Patients with AF were older (mean age 75±12 vs 64±14 years; p<0.001) and had a higher proportion of women (42.5% vs 34.5%; p<0.001) than patients without AF. STEMI patients with AF had a higher risk-adjusted in-hospital mortality (OR 1.15, 95% CI 1.12-1.19, p<0.001), longer average length of stay (7 days vs 4 days, P<0.001) and higher average total hospital charges ($74,082 vs $57,331, P<0.001) than those without AF. Using propensity matching, 57,388 STEMI patients with AF were compared with the same number of patients without AF. Within these matched cohorts, STEMI patients with AF had higher in-hospital mortality (16.7% vs 15.1%, OR 1.13, 95% CI 1.09-1.16; p<0.001), longer average length of stay (7 days vs 6 days, P<0.001), and higher average total hospital charges ($73,832 vs $65,201, P<0.001) than patients without AF. Conclusions: In patients hospitalized with STEMI, AF was independently associated with modestly higher in-hospital mortality, higher hospital charges, and longer length of stay.

scholarly journals 3517 Cancer-Related Pain is a Predictor of In-hospital Opioid Overdose among Postoperative patients

2019 ◽  
Vol 3 (s1) ◽  
pp. 36-36
Author(s):  
Nnaemeka E Onyeakusi ◽  
Fahad Mukhtar ◽  
Adebamike Oshunbade ◽  
Semiu Gbadamosi ◽  
Adeyinka Adejumo ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Charges ◽  
P Value ◽  
Opioid Overdose ◽  
Inpatient Mortality ◽  
Total Hospital ◽  
Patients With Cancer ◽  
Cancer Management ◽  
Cancer Pathogenesis ◽  
Diagnosis Of Cancer

OBJECTIVES/SPECIFIC AIMS: Our study’s primary aim is to determine if there is an association between cancer-related pain among patients who underwent major elective procedures and postoperative opioid overdose. In addition, the relationship between cancer-related pain in this population and inpatient mortality, total hospital charge and length of stay was assessed. METHODS/STUDY POPULATION: Our study sample consisted of adults 18 years and older who had at least one of eight elective procedures. Data was obtained from the National Inpatient Sample (NIS). Variables were identified using ICD-9 codes. Our primary predictor was cancer-related pain while our primary outcome was opioid overdose. Secondary outcomes were inpatient mortality, length of stay and total charge. Propensity-matched regression models were employed in assessing the association between cancer-related pain and outcomes of interest. RESULTS/ANTICIPATED RESULTS: Among 4,085,355 selected patients, 0.8% (n = 2,665) had cancer-related pain while 99.92% (n = 4,082,690) had no diagnosis of cancer-related pain. All subjects with cancer-related pain (n = 2,665) were successfully matched to subjects with no diagnosis of cancer-related pain in a 1:5 ratio yielding 13,325 controls. Patients with cancer-related pain had significantly higher odds of opioid overdose (aOR 4.82 [95% CI [2.68-8.67]; p-value <0.0001) and inpatient mortality (aOR 1.39[1.11-1.74]; p-value 0.0043). Patients with cancer-related pain were also likely to stay significantly longer in the hospital (12.76 days vs. 7.88 days) with significantly higher total hospital charges ($140,220 vs. $88,316). DISCUSSION/SIGNIFICANCE OF IMPACT: Pain is a common complication of cancer pathogenesis, diagnosis or treatment. Though a rare outcome, opioid overdose could lead to undesirable outcomes. Cancer patients undergo invasive diagnostic and therapeutic procedures as part of their cancer management or for conditions not related to their primary cancer diagnosis. Safety measures including alternatives to opioids are recommended to prevent the poor clinical outcomes and higher healthcare utilization indices associated with opioid overdose in this population.

scholarly journals Pengaruh Perubahan Status Gizi Pasien Dewasa terhadap Lama Rawat Inap dan Biaya Rumah Sakit

2004 ◽  
Vol 1 (1) ◽  
pp. 35
Author(s):  
R Dwi Budiningsari
Keyword(s):  
Length Of Stay ◽  
Nutritional Status ◽  
Global Assessment ◽  
Reference Group ◽  
Hospital Charge ◽  
Hospitalized Patients ◽  
Adult Patients ◽  
Hospital Charges ◽  
Subjective Global Assessment ◽  
Hospital Outcomes

Background: The decline in nutritional status of hospitalized patients was reported to be assossiated with longer length of stay and higher hospital charges. However, the effect of changes in nutritional status on hospital outcomes in Indonesia is still unknown.Objective: To determine the effect of changes in nutritional status on length of stay and hospital charge among adult hospitalized patients.Method: A total subjects of 262 adult patients who were admitted to internal and neurology departments of Dr. Sardjito, Dr.M.Jamil, and Sanglah hospitals were included in this study. Nutritional status of each patient was assessed using Subjective Global Assessment (SGA) method. Information on length of stay and hospital charge was collected based on medical records.Results: Subjects with nutritional status declined from normally to moderately, normally to severely, and moderately to severely malnourished were 6,3 (OR=6.32, 95% CI=1,3-29,8); 11,9 (OR=11.94, 95% CI=1,02-139,1); and 6,90 (OR=6.9, 95%CI=1,5-32,0 )times more likely to stay longer than those with nutritional status stayed normal during hospitalitation. They also had 3,3; unlimited; and 1,76 times risk on higher hospital charges than reference group (95% CI=1,123-9,529; unlimited; and 0,590-5,245).Conclusions: The declines of nutritional status from normally to moderately, normally to severely, and moderately to severely malnourished in hospitalized patients influenced to longer length of stay. Normally to moderately and normally to severely malnourished in hospitalized patients influenced to higher hospital charges.

Association of for-profit hospital ownership status with intracranial hemorrhage outcomes and cost of care

2020 ◽  
Vol 133 (6) ◽  
pp. 1939-1947
Author(s):  
Ryan G. Chiu ◽  
Blake E. Murphy ◽  
David M. Rosenberg ◽  
Amy Q. Zhu ◽  
Ankit I. Mehta
Keyword(s):  
Length Of Stay ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Hospital Charges ◽  
Inpatient Mortality ◽  
Total Hospital ◽  
Nonprofit Hospitals ◽  
For Profit ◽  
Ownership Status ◽  
Profit Centers

OBJECTIVEMuch of the current discourse surrounding healthcare reform in the United States revolves around the role of the profit motive in medical care. However, there currently exists a paucity of literature evaluating the effect of for-profit hospital ownership status on neurological and neurosurgical care. The purpose of this study was to compare inpatient mortality, operation rates, length of stay, and hospital charges between private nonprofit and for-profit hospitals in the treatment of intracranial hemorrhage.METHODSThis retrospective cohort study utilized data from the National Inpatient Sample (NIS) database. Primary outcomes, including all-cause inpatient mortality, operative status, patient disposition, hospital length of stay, total hospital charges, and per-day hospital charges, were assessed for patients discharged with a primary diagnosis of intracranial (epidural, subdural, subarachnoid, or intraparenchymal) hemorrhage, while controlling for baseline demographics, comorbidities, and interhospital differences via propensity score matching. Subgroup analyses by hemorrhage type were then performed, using the same methodology.RESULTSOf 155,977 unique hospital discharges included in this study, 133,518 originated from private nonprofit hospitals while the remaining 22,459 were from for-profit hospitals. After propensity score matching, mortality rates were higher in for-profit centers, at 14.50%, compared with 13.31% at nonprofit hospitals (RR 1.09, 95% CI 1.00–1.18; p = 0.040). Surgical operation rates were also similar (25.38% vs 24.42%; RR 0.96, 95% CI 0.91–1.02; p = 0.181). Of note, nonprofit hospitals appeared to be more intensive, with intracranial pressure monitor placement occurring in 2.13% of patients compared with 1.47% in for-profit centers (RR 0.69, 95% CI 0.54–0.88; p < 0.001). Discharge disposition was also similar, except for higher rates of absconding at for-profit hospitals (RR 1.59, 95% CI 1.12–2.27; p = 0.018). Length of stay was greater among for-profit hospitals (mean ± SD: 7.46 ± 11.91 vs 6.50 ± 8.74 days, p < 0.001), as were total hospital charges ($141,141.40 ± $218,364.40 vs $84,863.54 ± $136,874.71 [USD], p < 0.001). These findings remained similar even after segregating patients by subgroup analysis by hemorrhage type.CONCLUSIONSFor-profit hospitals are associated with higher inpatient mortality, lengths of stay, and hospital charges compared with their nonprofit counterparts.

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