Comparison of Risk-Standardized Readmission Rates of Surgical Patients at Safety-Net and Non–Safety-Net Hospitals Using Agency for Healthcare Research and Quality and American Hospital Association Data

Talutis, Stephanie D.; Chen, Qi; Wang, Na; Rosen, Amy K.

doi:10.1001/jamasurg.2018.5242

Cited by 16 publications

(18 citation statements)

References 23 publications

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“…The AHA Annual Survey has been linked to other databases and used for health services and outcomes research in obstetrics and a wide range of other specialties. [20][21][22][23]…”

Section: Data Sourcementioning

confidence: 99%

Services and payer mix of Black-serving hospitals and related severe maternal morbidity

Ona

Huang

Ananth

et al. 2021

American Journal of Obstetrics and Gynecology

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BACKGROUND: Black-serving hospitals are associated with increased maternal risk. However, prior administrative data research on maternal disparities has generally included limited hospital factors. More detailed evaluation of hospital factors related to obstetric outcomes may be important in understanding disparities. OBJECTIVE: To examine detailed characteristics of Black-serving hospitals and how these characteristics are associated with risk for severe maternal morbidity (SMM). METHODS: This serial cross-sectional study linked the 2010-2011 Nationwide Inpatient Sample and the 2013 American Hospital Association Annual Survey Databases. Delivery hospitalizations occurring to women 15-54 years of age were identified. The proportions of non-Hispanic Black patients within a hospital was categorized into quartiles, and hospital factors such as specialized medical, surgical and safety-net services as well as payer mix were compared across these quartiles. A series of models was performed evaluating risk for SMM with Black-serving hospital quartile as the primary exposure. Log linear regression models with a Poisson distribution (and robust variance) were performed with unadjusted and adjusted risk ratios (aRR) with 95% confidence intervals (CIs) as measures of effect.RESULTS: Overall 965,202 deliveries from 430 hospitals met inclusion criteria and were included in the analysis. By quartile, non-Hispanic Black patients accounted for 1.3%, 5.4%, 13.4%, and 33.8% of patients. Many services were significantly less common in the lowest compared to the highest Black-serving hospital quartile including cardiac intensive care (48.9% versus 74.5%), neonatal intensive care (28.9% versus 64.9%), pediatric intensive care (20.0% versus 45.7%), pediatric cardiology (29.6% versus 44.7%), and HIV/AIDS services (36.3% versus 71.3%) (p0.01 for all). Indigent care clinics, crisis prevention, and enabling services (p0.01 for all) were more common at Black-serving hospitals as was Medicaid payer. Following adjustments for detailed hospital factors, the lowest Black serving hospital quartile carried the lowest risk for SMM. However, SMM risks were similar across the 2 nd (aRR 1.31, 95% CI 1.08, 1.59), 3 rd (aRR 1.27, 95% 1.05, 1.55), and 4 th (aRR 1.29, 95% CI 1.07, 1.55) quartiles. CONCLUSION: Black-serving hospitals were more likely to provide a range of specialized medical, surgical, and safety-net services and to have a higher Medicaid burden. Payer mix and unmeasured confounding may account for some of the maternal risk associated with Black-serving hospitals.

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“…The AHA Annual Survey has been linked to other databases and used for health services and outcomes research in obstetrics and a wide range of other specialties. [20][21][22][23]…”

Section: Data Sourcementioning

confidence: 99%

Services and payer mix of Black-serving hospitals and related severe maternal morbidity

Ona

Huang

Ananth

et al. 2021

American Journal of Obstetrics and Gynecology

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“…Aside from EGS status, safety net hospitals, public insurance status, and non-English speaking have all been shown to be predictors of higher readmission rates. 3,10,11 Out of all patients who presented to a safety net hospital, over 85% of patients had public insurance/uninsured/charity care and 31% were non-English speakers. Public insurance status has also been associated with more complex initial presentation.…”

Section: Discussionmentioning

confidence: 99%

High Acuity of Postoperative Consults to Emergency General Surgery at an Urban Safety Net Hospital

Fiorentino

Mulles

Cue

et al. 2021

Journal of Surgical Research

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“…17 A high compliance rate is vital if SSI rates are to be reduced successfully, even if the bundles are comprised of strong evidence-based elements. 2 .3011 Coronary artery disease, n (%) 2.5 (3) 4.3 (13) .3857 Chronic kidney disease, n (%) 3.4 (4) 4 (12) .7584 Acute renal failure, n (%)…”

Section: Discussionmentioning

confidence: 99%

“…Academic Disproportionate Share Hospitals (ADSH) care for a disproportionately high percentage of underinsured and uninsured patients, who tend to have more chronic comorbidities and often result in more complicated clinical courses. 13 Patients at these institutions have a higher prevalence of obesity and comorbidity burdon than nonsafety-net patients. 14 These hospitals are also more likely to operate regional trauma centers and lead regional disaster programs.…”

Section: Introductionmentioning

confidence: 99%

The Impact of a Colorectal Care Bundle for Surgical Site Infections at an Academic Disproportionate Share Hospital With a Level I Trauma Center

Hajirawala

Legare

Tiu

et al. 2020

The American Surgeon™

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Objectives Colorectal care bundles for surgical site infections (CRCB-SSIs) have been shown to reduce SSIs following elective colorectal surgery (CRS). There are limited data evaluating the effect of CRCB-SSI at Academic Disproportionate Share Hospitals (ADSH) with significant rates of urgent and emergent cases. Methods A CRCB-SSI was implemented in April 2016. We reviewed medical records of all patients undergoing colon resections between August 2015 and December 2017. Patients were divided into preimplementation and postimplementation groups. The primary endpoint was the SSI rate, and the secondary endpoint included types of SSI (superficial, deep, organ space). Univariable and multivariable analyses were performed. A subset analysis was performed in elective cases. Results We analyzed a total of 417 patients. Of these, 116 (28%) and 301 (72%) patients were in the preimplementation and postimplementation groups, respectively. The rate of SSI decreased from 30.1% to 15.9% in the postimplementation group ( P = .0012); however, it was not statistically significant after adjusting for baseline differences (relative risk [RR] 0.65; 95% CI 0.41-1.02). The elective subset included 219 patients. The rate of SSI in this cohort decreased from 25% to 10.5% in the postimplementation group ( P = .0012) and remained significant following multivariable analysis (RR 0.41, 95% CI 0.19- 0.88). There were no differences in the subtypes of SSI. Discussion While the CRCB-SSI was effective in decreasing the postoperative SSI rate for elective cases, its effect on the overall patient population was limited. CRCB-SSIs are not enough to bring SSI rates to accepted rates in high-risk patients such as those seen at ADSH.

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Comparison of Risk-Standardized Readmission Rates of Surgical Patients at Safety-Net and Non–Safety-Net Hospitals Using Agency for Healthcare Research and Quality and American Hospital Association Data

Cited by 16 publications

References 23 publications

Services and payer mix of Black-serving hospitals and related severe maternal morbidity

Services and payer mix of Black-serving hospitals and related severe maternal morbidity

High Acuity of Postoperative Consults to Emergency General Surgery at an Urban Safety Net Hospital

The Impact of a Colorectal Care Bundle for Surgical Site Infections at an Academic Disproportionate Share Hospital With a Level I Trauma Center

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