Abstract
ObjectiveTo propose and evaluate a metric for quantifying hospital‐specific disparities in health outcomes that can be used by patients and hospitals.Data Sources/Study SettingInpatient admissions for Medicare patients with acute myocardial infarction, heart failure, or pneumonia to all non‐federal, short‐term, acute care hospitals during 2012‐2015.Study DesignBuilding on the current Centers for Medicare and Medicaid Services methodology for calculating risk‐standardized readmission rates, we developed models that include a hospital‐specific random coefficient for either patient dual eligibility status or African American race. These coefficients quantify the difference in risk‐standardized outcomes by dual eligibility and race at a given hospital after accounting for the hospital's patient case mix and proportion of dual eligible or African American patients. We demonstrate this approach and report variation and performance in hospital‐specific disparities.Principal FindingsDual eligibility and African American race were associated with higher readmission rates within hospitals for all three conditions. However, this disparity effect varied substantially across hospitals.ConclusionOur models isolate a hospital‐specific disparity effect and demonstrate variation in quality of care for different groups of patients across conditions and hospitals. Illuminating within‐hospital disparities can incentivize hospitals to reduce inequities in health care quality.
Highlights
Over the last decade, the Centers for Medicare and Medicaid Services (CMS) has promoted the use of quality measures in accountability programs with the goal of improving patient health care and well- being
With the goal of promoting health care equity, multiple stakeholders have proposed to highlight disparities in outcome measures by social risk factors.[7,8,9,10]. Despite these recommendations and persisting disparities in health outcomes,[11,12,13,14,15] few quality measures or methods have emerged for highlighting health care disparities, and none are in widespread use
We focused on the acute myocardial infarction (AMI), heart failure, and pneumonia readmission measure cohorts, which include inpatient admissions to all non-federal, short-term, acute care hospitals for Medicare fee-for-service (FFS)
Summary
To propose and evaluate a metric for quantifying hospital-specific disparities in health outcomes that can be used by patients and hospitals. Study Design: Building on the current Centers for Medicare and Medicaid Services methodology for calculating risk-standardized readmission rates, we developed models that include a hospital-specific random coefficient for either patient dual eligibility status or African American race. These coefficients quantify the difference in risk-standardized outcomes by dual eligibility and race at a given hospital after accounting for the hospital's patient case mix and proportion of dual eligible or African American patients. Principal Findings: Dual eligibility and African American race were associated with higher readmission rates within hospitals for all three conditions This disparity effect varied substantially across hospitals.
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