Abstract
Studies have shown that adverse events are associated with increasing inpatient care expenditures, but contemporary data on the association between expenditures and adverse events beyond inpatient care are limited. To evaluate whether hospital-specific adverse event rates are associated with hospital-specific risk-standardized 30-day episode-of-care Medicare expenditures for fee-for-service patients discharged with acute myocardial infarction (AMI), heart failure (HF), or pneumonia. This cross-sectional study used the 2011 to 2016 hospital-specific risk-standardized 30-day episode-of-care expenditure data from the Centers for Medicare & Medicaid Services and medical record-abstracted in-hospital adverse event data from the Medicare Patient Safety Monitoring System. The setting was acute care hospitals treating at least 25 Medicare fee-for-service patients for AMI, HF, or pneumonia in the United States. Participants were Medicare fee-for-service patients 65 years or older hospitalized for AMI, HF, or pneumonia included in the Medicare Patient Safety Monitoring System in 2011 to 2016. The dates of analysis were July 16, 2017, to May 21, 2018. Hospitals' risk-standardized 30-day episode-of-care expenditures and the rate of occurrence of adverse events for which patients were at risk. The final study sample from 2194 unique hospitals included 44 807 patients (26.1% AMI, 35.6% HF, and 38.3% pneumonia) with a mean (SD) age of 79.4 (8.6) years, and 52.0% were women. The patients represented 84 766 exposures for AMI, 96 917 exposures for HF, and 109 641 exposures for pneumonia. Patient characteristics varied by condition but not by expenditure category. The mean (SD) risk-standardized expenditures were $22 985 ($1579) for AMI, $16 020 ($1416) for HF, and $16 355 ($1995) for pneumonia per hospitalization. The mean risk-standardized rates of occurrence of adverse events for which patients were at risk were 3.5% (95% CI, 3.4%-3.6%) for AMI, 2.5% (95% CI, 2.5%-2.5%) for HF, and 3.0% (95% CI, 2.9%-3.0%) for pneumonia. An increase by 1 percentage point in the rate of occurrence of adverse events was associated with an increase in risk-standardized expenditures of $103 (95% CI, $57-$150) for AMI, $100 (95% CI, $29-$172) for HF, and $152 (95% CI, $73-$232) for pneumonia per discharge. Hospitals with high adverse event rates were more likely to have high 30-day episode-of-care Medicare expenditures for patients discharged with AMI, HF, or pneumonia.
Highlights
The US health care system is moving toward high-value care, with the goal of producing the best health outcomes at the lowest cost.[1,2] Reducing both expenditures and hospital-acquired adverse events are 2 important aspects of this goal[3,4] because health care expenditures are projected to increase faster than the US gross domestic product over the 2015 to 2025 period.[5]
The mean risk-standardized rates of occurrence of adverse events for which patients were at risk were 3.5% for acute myocardial infarction (AMI), 2.5% for heart failure (HF), and 3.0% for pneumonia
Hospitals with high adverse event rates were more likely to have high 30-day episode-of-care Medicare expenditures for patients discharged with AMI, HF, or pneumonia
Summary
The US health care system is moving toward high-value care, with the goal of producing the best health outcomes at the lowest cost.[1,2] Reducing both expenditures and hospital-acquired adverse events are 2 important aspects of this goal[3,4] because health care expenditures are projected to increase faster than the US gross domestic product over the 2015 to 2025 period.[5]. A conceptual association between adverse events and expenditures could be that patients who have in-hospital adverse events may require additional expenditures to treat these adverse events Such additional expenditures may occur after discharge. Restricted by available data, previous studies were limited by the use of only a small number of measures[17,18] and were largely focused on inpatient cost.[9,11,19,20,21,22,23,24,25,26,27] Information is needed to examine the association between hospital performance on adverse events and hospital performance on episode-of-care expenditures within a standard period after admission in a contemporary and national cohort
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