The quality of surgical care in safety net hospitals: A systematic review

Mouch, Charles A.; Regenbogen, Scott E.; Revels, Sha’Shonda L.; Wong, Sandra L.; Lemak, Christy Harris; Morris, Arden M.

doi:10.1016/j.surg.2013.12.006

Cited by 65 publications

(40 citation statements)

References 31 publications

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“…18 These findings were reinforced by a recent systematic review that found that SNHs had worse performance than non-SNHs in measures of timeliness and patient-centeredness, with less equitable surgical care. 19 These investigations, together with ours, suggest that increased SNH readmission rates might be driven predominantly by hospitals rather than patient factors.…”

Section: Discussionsupporting

confidence: 60%

“…18,19 Similar to a systematic review by Mouch and colleagues, 19 which evaluated the quality of SNHs based on hospital factors of safety, effectiveness, efficiency, timeliness, patient-centeredness, and equity, our study focused on hospital factors, such as number of beds, ownership status, teaching status, and having a Commission on Cancer-designated cancer program within the American Hospital Association database. Although different variables were analyzed for patient care outcomes at SNH, both studies revealed hospital-based infrastructures that were inferior to those of non-SNHs.…”

Section: Discussionmentioning

confidence: 99%

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Vulnerable Hospitals and Cancer Surgery Readmissions: Insights into the Unintended Consequences of the Patient Protection and Affordable Care Act

Hong

Zheng

Hechenbleikner

et al. 2016

Journal of the American College of Surgeons

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BACKGROUND Penalties from the Hospital Readmission Reduction Program can push financially strained, vulnerable patient-serving hospitals into additional hardship. In this study, we quantified the association between vulnerable hospitals and readmissions and examined the respective contributions of patient- and hospital-related factors. METHODS A total of 110,857 patients who underwent major cancer operations were identified from the 2004–2011 State Inpatient Database of California. Vulnerable hospitals were defined as either self-identified safety net hospitals (SNHs) or hospitals with a high percentage of Medicaid patients (high Medicaid hospitals [HMHs]). We used multivariable logistic regression to determine the association between vulnerable hospitals and readmission. Patient and hospital contributions to the elevation in odds of readmission were assessed by comparing estimates from models with different subsets of predictors. RESULTS Of the 355 hospitals, 13 were SNHs and 31 were HMHs. After adjusting for Hospital Readmission Reduction Program variables, SNHs had higher 30-day (odds ratio [OR] = 1.32; 95% CI, 1.18–1.47), 90-day (OR = 1.28; 95% CI, 1.18–1.38), and repeated readmissions (OR = 1.33; 95% CI, 1.18–1.49); HMHs also had higher 30-day (OR = 1.18; 95% CI, 1.05–1.32), 90-day (OR = 1.28; 95% CI, 1.16–1.42), and repeated readmissions (OR = 1.24; 95% CI, 1.01–1.54). Compared with patient characteristics, hospital factors accounted for a larger proportion of the increase in odds of readmission among SNHs (60% to 93% vs 24% to 39%), but a smaller proportion among HMHs (9% to 15% vs 60% to 115%). CONCLUSIONS Vulnerable status of hospitals is associated with higher readmission rates after major cancer surgery. These findings reinforce the call to account for socioeconomic variables in risk adjustments for hospitals who serve a disproportionate share of disadvantaged patients.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Vulnerable Hospitals and Cancer Surgery Readmissions: Insights into the Unintended Consequences of the Patient Protection and Affordable Care Act

Hong

Zheng

Hechenbleikner

et al. 2016

Journal of the American College of Surgeons

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“…acute care rehabilitation). However, Harda, Chun, and Chiu estimated that patients in disproportionate share hospitals were less likely to receive acute care physical therapy after hip fracture treatments relative to patients receiving care in non-disproportionate share hospitals [44]; a result that supports the concept that the treatment patients receive and their subsequent health outcomes may differ on components beyond demographic characteristics, such as hospital based-factors [16,17,24,25]. Other patient-based variables, such as health insurance type, were also associated with LOS both within and between hospital categories.…”

Section: Discussionmentioning

confidence: 95%

“…In addition to other hospital types [16,17], researchers found outcome differences between patients treated at SNH and those treated at NSNH [8,[25][26][27][28]. Furthermore, Kumar et al [29] estimated that hip fracture patient outcomes differed within a skilled nursing facility based upon patients' health insurance types.…”

Section: Introductionmentioning

confidence: 99%

Disparities in length of stay for hip fracture treatment between patients treated in safety-net and non-safety-net hospitals

Coffield

Thirunavukkarasu

et al. 2020

BMC Health Serv Res

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Background: Length of hospital stay (LOS) for hip fracture treatments is associated with mortality. In addition to patient demographic and clinical factors, hospital and payer type may also influence LOS, and thus mortality, among hip fracture patients; accordingly, outcome disparities between groups may arise from where patients are treated and from their health insurance type. The purpose of this study was to examine if where hip fracture patients are treated and how they pay for their care is associated with outcome disparities between patient groups. Specifically, we examined whether LOS differed between patients treated at safety-net and non-safety-net hospitals and whether LOS was associated with patients' insurance type within each hospital category. Methods: A sample of 48,948 hip fracture patients was extracted from New York State's Statewide Planning and Research Cooperative System (SPARCS), 2014-2016. Using means comparison and X 2 tests, differences between safety-net and non-safety-net hospitals on LOS and patient characteristics were examined. Relationships between LOS and hospital category (safety-net or non-safety-net) and LOS and insurance type were further evaluated through negative binomial regression models. Results: LOS was statistically (p ≤ 0.001) longer in safety-net hospitals (7.37 days) relative to non-safety-net hospitals (6.34 days). Treatment in a safety-net hospital was associated with a LOS that was 11.7% (p = 0.003) longer than in a non-safety-net hospital. Having Medicaid was associated with a longer LOS relative to having commercial health insurance. Conclusion: Where hip fracture patients are treated is associated with LOS and may influence outcome disparities between groups. Future research should examine whether outcome differences between safety-net and non-safety-net hospitals are associated with resource availability and hospital payer mix.

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“…Qualitative methodology was evaluated based on use of an explicit sampling strategy, description of data analysis, statement of final themes and definitions, use of procedures to validate findings, and statement of strategies to achieve consensus among coders (Supplement 5). 17,19 None of the included studies demonstrated major lapses in methodologic quality.…”

Section: Assessment Of Methodologic Quality and Risk Of Biasmentioning

confidence: 99%

Characterizing the Role of U.S. Surgeons in the Provision of Palliative Care: A Systematic Review and Mixed-Methods Meta-Synthesis

Suwanabol

Kanters

Reichstein

et al. 2018

Journal of Pain and Symptom Management

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The quality of surgical care in safety net hospitals: A systematic review

Cited by 65 publications

References 31 publications

Vulnerable Hospitals and Cancer Surgery Readmissions: Insights into the Unintended Consequences of the Patient Protection and Affordable Care Act

Vulnerable Hospitals and Cancer Surgery Readmissions: Insights into the Unintended Consequences of the Patient Protection and Affordable Care Act

Disparities in length of stay for hip fracture treatment between patients treated in safety-net and non-safety-net hospitals

Characterizing the Role of U.S. Surgeons in the Provision of Palliative Care: A Systematic Review and Mixed-Methods Meta-Synthesis

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