1. A Profile of Patient Care and Safety in Hospitals with Differing Case-Mix and Financial Condition Sema K. Aydede, PhD Institute for Child Health Policy, University of Florida ( for the Research Project Team ) Funded by Agency for Healthcare Research and Quality Grant # R01 HS13094

2. Background 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)

3. Research Questions What differences exist in the quality of inpatient care and safety across hospital groups? 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?

4. Methods and Key Variables 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

5. Methods and Key Variables Inpatient Quality Indicators (IQI) AMI, CHF, Acute Stroke, GI Hemorrhage, Pneumonia Patient Safety Indicators (PSI) 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 Hospital patient age distribution, gender and race

6. Results – Hospital Structure and Organizational Characteristics,1995 DistressedNon-Distressed Low Severity High Severity Low Severity High Severity Bed Size (mean)187.32227.15164.82213.36 Publicly Owned (%)31.4321.5910.539.02 Major Teaching (%)8.7814.023.223.38 System Member (%)33.0539.3951.8056.39 Medicaid Payer (%)23.3519.5918.4712.65 RN FTEs/1000 Case-Mix APDs2.272.182.482.37

7. Results–CHF Mortality Rate IQI 16

8. Results–Stroke Mortality Rate IQI 17

9. Results–GI Hemorrhage Mortality Rate IQI 18

10. Results–Pneumonia Mortality Rate IQI 20

11. Results – Decubitus Ulcer PSI 03

12. Results – Infection Due to Medical Error PSI 07

13. Results–Post-Operative PE or DVT PSI 12

14. Results No significant differences across hospital groups IQI – AMI PSI – Sentinel event indicators (Complications of Anesthesia and Death in Low Mortality DRG) No clear pattern across hospital groups PSI – Technical complication indicators (Post-OP Hemorrhage or Hematoma and Accidental Puncture or Laceration)

15. Summary 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

16. Significance to Policy and Future Research Learning by doing may overcome adverse effects of financial distress for IQI 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