Hospital Characteristics and Mortality Rates

Abstract

The Health Care Financing Administration (HCFA) publishes hospital mortality rates each year. We undertook a study to identify characteristics of hospitals associated with variations in these rates. To do so, we obtained data on 3100 hospitals from the 1986 HCFA mortality study and the American Hospital Association's 1986 annual survey of hospitals. The mortality rates were adjusted for each hospital's case mix and other characteristics of its patients. The mortality rate for all hospitalizations was 116 per 1000 patients. Adjusted mortality rates were significantly higher for for-profit hospitals (121 per 1000) and public hospitals (120 per 1000) than for private not-for-profit hospitals (114 per 1000; P less than 0.0001 for both comparisons). Osteopathic hospitals also had an adjusted mortality rate that was significantly higher than average (129 per 1000; P less than 0.0001). Private teaching hospitals had a significantly lower adjusted mortality rate (108 per 1000) than private nonteaching hospitals (116 per 1000; P less than 0.0001). Adjusted mortality rates were also compared for hospitals in the upper and lower fourths of the sample in terms of certain hospital characteristics. The mortality rates were 112 and 121 per 1000 for the hospitals in the upper and lower fourths, respectively, in terms of the percentage of physicians who were board-certified specialists (P less than 0.0001), 112 and 120 per 1000 for occupancy rate (P less than 0.0001), 113 and 120 per 1000 for payroll expenses per hospital bed (P less than 0.0001), and 113 and 119 per 1000 for the percentage of nurses who were registered (P less than 0.0001).

Outcomes of variation in hospital nurse staffing in English hospitals: Cross-sectional analysis of survey data and discharge records

“…A robust evidence base of studies demonstrating that better hospital nurse staffing is associated with more favourable patient outcomes has stimulated both legislative and voluntary actions by hospitals in the US to improve staffing levels (Aiken et al, 2002a, b;Estabrooks et al, 2005;Moses and Mosteller, 1968;Hartz et al, 1989;Needleman et al, 2002;Page, 2004;Lang et al, 2004;Kazanjian et al, 2005;Spetz, 2004 …”

“…A robust evidence base of studies demonstrating that better hospital nurse staffing is associated with more favourable patient outcomes has stimulated both legislative and voluntary actions by hospitals in the US to improve staffing levels (Aiken et al, 2002a, b;Estabrooks et al, 2005;Moses and Mosteller, 1968;Hartz et al, 1989;Needleman et al, 2002;Page, 2004;Lang et al, 2004;Kazanjian et al, 2005;Spetz, 2004). While many concerns about the quality of hospital care are shared internationally (McKee et al, 1997;McKee et al, 1998), decision-makers in other countries have not always considered these US findings to be applicable to their particular national contexts.…”

“…In the US study, every one patient added to the average hospital-wide nurse workload increased the risk of death following common surgical procedures by 7% (Aiken et al, 2002a, b). There was a 31% difference in mortality between hospitals in which registered nurses cared for 8 patients each and those in which nurses cared for 4 patients each after taking into account patients' severity of illness and co-morbid conditions, and the size, technology level, and teaching status of the treating hospitals.Findings from the Canadian arm of the international study mirror those in the US, most notably, a staffing skill mix with a higher proportion of registered nurses was associated with significantly lower mortality (Estabrooks et al, 2005).A robust evidence base of studies demonstrating that better hospital nurse staffing is associated with more favourable patient outcomes has stimulated both legislative and voluntary actions by hospitals in the US to improve staffing levels (Aiken et al, 2002a, b;Estabrooks et al, 2005;Moses and Mosteller, 1968;Hartz et al, 1989;Needleman et al, 2002;Page, 2004;Lang et al, 2004;Kazanjian et al, 2005;Spetz, 2004 …”

Nurse Staffing, Mortality, and Length of Stay in For-Profit and Not-for-Profit Hospitals

“…1 See particularly Hartz et al 1989;Al-Haider and Wan 1991;Keeler et al 1992;Shortell and Hughes 1988;Sloan et al 2001. One systematic review of the literature focused specifically on studies of hospital mortality published through 2001.…”

Hospital capacity and post-transplant survival after allogeneic bone marrow transplantation: analysis of data from the Japan Society for Hematopoietic Cell Transplantation

“…for total hospital mortality rate, 1 and specific diseases 2 and/or treatment modes such as heart transplants 3 and other surgeries, [4][5][6][7] mainly in the United States. Among hospital characteristics accumulated experience has been reported to be significant in many situations; lower mortality is generally associated with hospitals with a large capacity compared to those with limited experience.…”