Objective To propose and evaluate a metric for quantifying hospital‐specific disparities in health outcomes that can be used by patients and hospitals. Data Sources/Study Setting Inpatient admissions for Medicare patients with acute myocardial infarction, heart failure, or pneumonia to all non‐federal, short‐term, acute care hospitals during 2012‐2015. Study Design Building on the current Centers for Medicare and Medicaid Services methodology for calculating risk‐standardized readmission rates, we developed models that include a hospital‐specific random coefficient for either patient dual eligibility status or African American race. These coefficients quantify the difference in risk‐standardized outcomes by dual eligibility and race at a given hospital after accounting for the hospital's patient case mix and proportion of dual eligible or African American patients. We demonstrate this approach and report variation and performance in hospital‐specific disparities. Principal Findings Dual eligibility and African American race were associated with higher readmission rates within hospitals for all three conditions. However, this disparity effect varied substantially across hospitals. Conclusion Our models isolate a hospital‐specific disparity effect and demonstrate variation in quality of care for different groups of patients across conditions and hospitals. Illuminating within‐hospital disparities can incentivize hospitals to reduce inequities in health care quality.

During December 2019, an outbreak of unexplained pneumonia occurred in Wuhan, Hubei Province. The disease was subsequently named coronavirus disease 2019 (COVID-19) and the causative virus as severe acute respiratory syndrome conronavirus-2 (SARS-CoV-2). Based on experience, it is vital to exclude or diagnose suspected patients as soon as possible to prevent disease spread. Our hospital is a COVID-19 designated hospital in Wuhan. During the epidemic period, there was a reconstruction of the medical facilities to accommodate patients with different disease status. We document the development of “suspected ward,” a ward that cared for patients with suspected COVID-19, in a large designated hospital during the COVID-19 outbreak in Wuhan City, China, and explain the suspected ward spatial layout, organization structure, diagnosis, and treatment flow chart of suspected cases. The key characteristics of our “suspected ward” is isolation, triage, fast diagnosis, and rapid referral. Our description of this suspected ward provides a reference for further improvements in the care of patients with suspected disease in emergency medical institutions.

Background: The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals for higher-than-expected readmission rates. Almost 20% of Medicare fee-for-service (FFS) patients receive postacute care in skilled nursing facilities (SNFs) after hospitalization. SNF patients have high readmission rates. Objective: The objective of this study was to investigate the association between changes in hospital referral patterns to SNFs and HRRP penalty pressure. Design: We examined changes in the relationship between penalty pressure and outcomes before versus after HRRP announcement among 2698 hospitals serving 6,936,393 Medicare FFS patients admitted for target conditions: acute myocardial infarction, heart failure, or pneumonia. Hospital-level penalty pressure was the expected penalty rate in the first year of the HRRP multiplied by Medicare discharge share. Outcomes: Informal integration measured by the percentage of referrals to hospitals’ most referred SNF; formal integration measured by SNF acquisition; readmission-based quality index of the SNFs to which a hospital referred discharged patients; referral rate to any SNF. Results: Hospitals facing the median level of penalty pressure had modest differential increases of 0.3 percentage points in the proportion of referrals to the most referred SNF and a 0.006 SD increase in the average quality index of SNFs referred to. There were no statistically significant differential increases in formal acquisition of SNFs or referral rate to SNF. Conclusions: HRRP did not prompt substantial changes in hospital referral patterns to SNFs, although readmissions for patients referred to SNF differentially decreased more than for other patients, warranting investigation of other mechanisms underlying readmissions reduction.