Background
A Profile of Patient Care and
Safety in Hospitals with Differing
Case-Mix and Financial Condition
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Sema K. Aydede, PhD
Institute for Child Health Policy, University of Florida
(for the Research Project Team)
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Funded by
Agency for Healthcare Research and Quality
Grant # R01 HS13094
Research Questions
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What differences exist in the quality of
inpatient care and safety across hospital
groups?
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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
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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
Results – Hospital Structure and
Organizational Characteristics,1995
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
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Distressed
AMI, CHF, Acute Stroke, GI Hemorrhage, Pneumonia
Patient Safety Indicators (PSI)
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Methods and Key Variables
Inpatient Quality Indicators (IQI)
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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)
Hospital patient age distribution, gender and race
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
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Results–CHF Mortality Rate
Results–Stroke Mortality Rate
IQI 16
IQI 17
0.07
0.16
0.06
0.14
0.05
0.12
0.04
Rates
Rates
0.1
0.03
0.08
0.06
0.02
0.04
0.01
0.02
0
0
1996
1997
1998
1999
1996
2000
1997
1998
Dis tres sed/High-Severity
1999
2000
Years
Ye ars
Dis tress ed/Low-Severity
Non-Dis tress ed/Low-Severity
Distressed/Low-Severity
Non-Dis tres s ed/High-Severity
Distressed/High-Severity
Non-Distressed/Low-Severity
Non-Distressed/High-Severity
Results–Pneumonia Mortality Rate
Results–GI Hemorrhage Mortality Rate
IQI 18
IQI 20
0.12
0.045
0.04
0.1
0.035
0.08
0.03
Rate
Rate
0.025
0.02
0.06
0.015
0.04
0.01
0.02
0.005
0
1996
1997
1998
1999
2000
0
Ye ars
Distressed/Low-Severity
Distressed/High-Severity
1996
Non-Distressed/Low-Severity
1997
1998
1999
2000
Years
Non-Distressed/High-Severity
Distressed/Low-Severity
Results – Decubitus Ulcer
Distressed/High-Severity
Non-Distressed/Low-Severity
Non-Distressed/High-Severity
Results – Infection Due to Medical Error
PSI 03
PSI 07
0.025
0.025
0.02
0.02
0.015
Rates
Rates
0.015
0.01
0.01
0.005
0.005
0
1996
1997
0
1996
1997
1998
1999
Years
Dis tress ed/Low-Severity
Distres sed/High-Severity
Non-Distressed/Low-Severity
1998
1999
2000
Years
2000
Distressed/Low -Severity
Distressed/High-Severity
Non-Distressed/Low -Severity
Non-Distressed/High-Severity
Non-Distressed/High-Severity
2
Results–Post-Operative PE or DVT
Results
PSI 12
0.01
No significant differences across hospital
groups
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0.009
0.008
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0.007
Rates
0.006
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0.005
0.004
No clear pattern across hospital groups
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0.003
0.002
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0.001
0
1996
1997
1998
1999
IQI – AMI
PSI – Sentinel event indicators (Complications of
Anesthesia and Death in Low Mortality DRG)
2000
PSI – Technical complication indicators (Post-OP
Hemorrhage or Hematoma and Accidental Puncture
or Laceration)
Ye ars
Dist r essed/ Low- Sever it y
Di st r essed/ Hi gh- Sever i t y
Non- Di st r essed/ Low- Sever i t y
Non- Di st r essed/ Hi gh- Sever i t y
Significance to Policy and
Future Research
Summary
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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
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Learning by doing may overcome adverse effects
of financial distress for IQI
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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
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