Health disparities and stroke: the influence of insurance status on the prevalence of patient safety indicators and hospital-acquired conditions

Abstract

OBJECT The Agency for Healthcare Research and Quality patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) are publicly reported quality metrics linked directly to reimbursement. The occurrence of PSIs and HACs is associated with increased mortality and hospital costs after stroke. The relationship between insurance status and PSI and HAC rates in hospitalized patients treated for acute ischemic stroke was determined using the Nationwide Inpatient Sample (NIS) database. METHODS The NIS was queried for all hospitalizations involving acute ischemic stroke between 2002 and 2011. The rate of each PSI and HAC was determined by searching the hospital records for ICD-9 codes. The SAS statistical software package was used to calculate rates and perform multivariable analyses to determine the effects of patient variables on the probability of developing each indicator. RESULTS The NIS query revealed 1,507,336 separate patient admissions that had information on both primary payer and hospital teaching status. There were 227,676 PSIs (15.1% of admissions) and 42,841 HACs reported (2.8%). Patient safety indicators occurred more frequently in Medicaid/self-pay/no-charge patients (19.1%) and Medicare patients (15.0%) than in those with private insurance (13.6%; p < 0.0001). In a multivariable analysis, Medicaid, self-pay, or nocharge patients had significantly longer hospital stays, higher mortality, and worse outcomes than those with private insurance (p < 0.0001). CONCLUSIONS Insurance status is an independent predictor of patient safety events after stroke. Private insurance is associated with lower mortality, shorter lengths of stay, and improved clinical outcomes.

Insurance status and reportable quality metrics in the cervical spine fusion population

“…[19] The adverse effect of PSI on patient outcomes has been well documented. [21, 32, 33] In addition to the ethical obligation for physicians to provide high quality care for their patients, physician and hospital reimbursement is increasingly tied to care quality. Rajaram et al used CMS, Center for Disease Control (CDC), and Medicare data to show that 721 hospitals (22% of all participating hospitals) were financially penalized for substandard quality of care in the first year (fiscal year 2015) of the CMS HAC Reduction Program.…”

Patient Safety Behavior in Physicians: How is it Predicted?

“…Another study indicated that private insurance is associated with lower mortality, shorter lengths of stay, and improved clinical outcomes [23]. It seems that patients with higher financial capabilities who can be hospitalized in private hospitals have a generally higher safety rate.…”

Disparities in Reportable Quality Metrics by Insurance Status in the Primary Spine Neoplasm Population

“…Although the incidence of adverse safety events has been quantified in multiple patient populations [3,7,9,14,24,25,35,36], no prior study has quantified the incidence of adverse events in patients undergoing hospitalization for primary spinal cord neoplasms using PSI as a metric. In the present study, we observed a lower incidence of PSI in patients treated for primary spinal cord neoplasms (2.8%) compared to prior studies of other neurosurgical patient populations.…”

“…[1][2][3][4][5][6][7][8][9] Although acquiring health insurance may play a role in reducing disparities across socioeconomic groups, [10][11][12] expanding health insurance access does not guarantee that patients receive high quality care. [9,13,14] The Hospital Value Based Purchasing Program, implemented by the Centers for Medicare and Medicaid Services (CMS) as part of the Affordable Care Act (ACA), links healthcare quality with healthcare reimbursements to improve the quality of care received by all patients, regardless of socioeconomic or insurance status. [15,16] CMS measures healthcare quality and patient safety according to a suite of patient safety indicators (PSI) developed by the Agency for Healthcare Research and Quality (AHRQ).…”