Mortality Rates Similar for Safety-Net and Other Hospitals, AHRQ Study Finds

A new AHRQ-funded study found that safety-net hospitals appeared to perform equally as well as other hospitals when evaluated according to medical and surgical mortality rates. The researchers analyzed 2006–2011 data from 1,891 urban, nonfederal, general acute hospitals in 31 states. Findings suggested that despite ongoing financial disadvantages faced by safety-net hospitals, the quality of care at these hospitals as measured by inpatient mortality was mostly comparable to that at other hospitals. Results also showed that mortality rates actually declined over time for all hospitals, according to the data from AHRQ’s Healthcare Cost and Utilization Project and other sources. “Measuring Mortality Performance: How Did Safety-Net Hospitals Compare with Other Hospitals?” appeared in the July issue of Medical Care. Access theabstract.

2016 Jul;54(7):648-56. doi: 10.1097/MLR.0000000000000540.

Measuring Mortality Performance: How Did Safety-Net Hospitals Compare With Other Hospitals?

Jiang HJ1, Reiter KL, Wang J.

Author information

Abstract

BACKGROUND:

Safety-net hospitals (SNHs) tend to be weaker in financial condition than other hospitals, leading to a concern about how the quality of care at these hospitals would compare to other hospitals.

OBJECTIVES:

To assess mortality performance of SNHs using all-payer databases and measures for a broad range of conditions and procedures.

DESIGN:

Longitudinal analysis of hospitals from 2006 through 2011 with data from the Healthcare Cost and Utilization Project State Inpatient Databases, the American Hospital Association Annual Survey, and the Area Health Resources File.

SUBJECTS:

A total of 1891 urban, nonfederal, general acute hospitals from 31 states.

METHODS:

SNHs were identified by the percentage of Medicaid and uninsured patients. Hospital mortality performance was measured by 2 composites covering 6 common medical conditions and 4 surgical procedures with risk adjustment for patient characteristics. Differences in each composite between SNHs and non-SNHs were estimated through generalized estimating equations to control for hospital factors and community resources.

RESULTS:

Inpatient mortality rates declined over time for all hospitals. Small differences in risk-adjusted mortality rates between SNHs and non-SNHs were found only among teaching hospitals. After controlling for hospital factors, these differences were substantially reduced and remained significant only for surgical mortality rates. The small gap in surgical mortality rates diminished in later years.

CONCLUSIONS:

SNHs appeared to perform equally well as other hospitals in medical and surgical mortality measures. Policymakers should continue to monitor the quality of care at SNHs and ensure that it would not decline under the current value-based purchasing program.