American Hospital Association Data Research Articles

Hospitals with decreasing cost-to-charge ratios bill greater surgical charges for similar outcomes

BackgroundThe cost-to-charge ratio reflects the markup of hospital services. A lower cost-to-charge ratio indicates lower costs and/or greater charges. This study examines factors associated with cost-to-charge ratio trends to determine whether decreasing cost-to-charge ratio is associated with worse surgical outcomes. MethodsThe Florida Agency for Healthcare Administration Inpatient database (2018–2020) was queried for common surgical procedures and linked to the Distressed Communities Index, RAND Corporation Hospital data, Center for Medicare Services Cost Reports, and American Hospital Association data. Only hospitals with monotonically increasing or decreasing cost-to-charge ratio were included in the study. Univariable analysis compared these hospitals. Using patient-level data, interpretable machine learning predicted cost-to-charge ratio trend while identifying influential factors. ResultsThe cohort had 67 hospitals (27 increasing cost-to-charge ratio and 40 decreasing cost-to-charge ratio) with 35,661 surgeries. Decreasing cost-to-charge ratio hospitals were more often proprietarily owned (78% vs 33%, P = .01) and had greater mean total charges ($134,349 ± $114,510 vs $77,185 ± $82,027, P < .01) with marginally greater mean estimated costs ($14,863 ± $12,343 vs $14,458 ± $15,440, P < .01). Patients from decreasing cost-to-charge ratio hospitals had greater rates of most comorbidities (P < .05) but no difference in mortality or overall complications. Machine-learning models revealed charges rather than clinical factors as most influential in cost-to-charge ratio trend prediction. ConclusionsDecreasing cost-to-charge ratio hospitals charge vastly more despite minimally greater estimated costs and no difference in outcomes. Although differences in case-mix existed, charges were the predominant differentiators. Patient clinical factors had far less of an impact.

Association between characteristics of employing healthcare facilities and healthcare worker infection rates and psychosocial experiences during the COVID-19 pandemic

BackgroundHealthcare facility characteristics, such as ownership, size, and location, have been associated with patient outcomes. However, it is not known whether the outcomes of healthcare workers are associated with the characteristics of their employing healthcare facilities, particularly during the COVID-19 pandemic.MethodsThis was an analysis of a nationwide registry of healthcare workers (the Healthcare Worker Exposure Response and Outcomes (HERO) registry). Participants were surveyed on their personal, employment, and medical characteristics, as well as our primary study outcomes of COVID-19 infection, access to personal protective equipment, and burnout. Participants from healthcare sites with at least ten respondents were included, and these sites were linked to American Hospital Association data to extract information about sites, including number of beds, teaching status, urban/rural location, and for-profit status. Generalized estimating equations were used to estimate linear regression models for the unadjusted and adjusted associations between healthcare facility characteristics and outcomes.ResultsA total of 8,941 healthcare workers from 97 clinical sites were included in the study. After adjustment for participant demographics, healthcare role, and medical comorbidities, facility for-profit status was associated with greater odds of COVID-19 diagnosis (aOR 1.76, 95% CI 1.02–3.03, p = .042). Micropolitan location was associated with decreased odds of COVID-19 infection after adjustment (aOR = 0.42, 95% CI 0.24, 0.71, p = .002. For-profit facility status was associated with decreased odds of burnout after adjustment (aOR = 0.53, 95% CI 0.29–0.98), p = .044).ConclusionsFor-profit status of employing healthcare facilities was associated with greater odds of COVID-19 diagnosis but decreased odds of burnout after adjustment for demographics, healthcare role, and medical comorbidities. Future research to understand the relationship between facility ownership status and healthcare outcomes is needed to promote wellbeing in the healthcare workforce.Trial registrationThe registry was prospectively registered: ClinicalTrials.gov Identifier (trial registration number) NCT04342806, submitted April 8, 2020.

Do hospital data breaches affect health information technology investment?

Objectives Data breaches are a financial and operational threat to hospitals. In this study, we examine the association between a data breach and information technology capital and labor investment. Methods In this retrospective cohort study, we used American Hospital Association data from 2017 to 2019 and an unbalanced panel of hospitals with 6751 unique hospital-year observations. The breached group had 482 hospital-years, and the control group had 6269 hospital-years. We estimated the association between data breaches, information technology capital, and labor investment using the average treatment effect with propensity-score matching. Results From 2017 to 2019, hospitals experienced more hacking and information technology incidents but fewer thefts and losses. We found that hospital data breaches were associated with a 66% increase in employed information technology staff and a 57% increase in outsourced information technology staff. Breaches were not associated with information technology operating expenses and information technology capital expenses. Conclusion Higher information technology labor investment due to the remediation of data breaches is an added cost to the healthcare system. Hospitals and policymakers should consider initiatives to improve cybersecurity and protect patient data.

Advanced practice nurse case managers improve efforts by US hospitals to address patient social needs.

US hospitals are focussing more than ever on meeting important patient social needs. Patients often make multiple trips to hospitals related to nonmedical issues that could likely be averted through the increased integration of case management strategies. Although the percentage of hospitals using advanced practice nurses (APNs) in this role is still relatively low, we explore the idea that employing APN case managers improves hospitals' abilities to alleviate hospital overusage. The study used a cross-sectional design. We used the 2021 American Hospital Association data set, which includes 5855 hospitals, of which 4315 were general medical hospitals. Using descriptive statistics and Poisson regression, we discovered that employing APN case managers in US acute care hospitals is associated with an increased likelihood that hospitals will implement strategies addressing patient social needs. When hospitals screen patients for social needs and formulate and implement internal and external strategies designed to meet patient social needs, many stakeholders stand to benefit. Should more hospitals observe such benefits when utilizing an APN case manager model, it will likely proliferate, and demand for APNs could accelerate further. Following the reduction in unnecessary patient visits and readmissions, hospitals' scarce resources are freed up to offer timely care to patients that are truly medically in need. Furthermore, financial performance improves under this scenario. APNs play a critical role in enabling hospitals to realize such benefits. No patient or public contribution. We used archival data in this study.

Emergency Department and Health Care System Factors Associated with Telehealth Innovation During the COVID-19 Pandemic.

Objective: Telehealth capacity may be an important component of pandemic response infrastructure. We aimed to examine changes in the telehealth use by the US emergency departments (EDs) during COVID-19, and to determine whether existing telehealth infrastructure or increased system integration were associated with increased likelihood of use. Methods: We analyzed 2016-2020 National ED Inventory (NEDI)-USA data, including ED characteristics and nature of telehealth use for all US EDs. American Hospital Association data characterized EDs' system integration. An ordinary least-squares regression model obtained one-step-ahead forecast of the expected proportion of EDs using telehealth in 2020 based on growth observed from 2016 to 2019. Among EDs without telehealth in 2019, we used logistic regression models to examine whether system membership or existing telehealth infrastructure were associated with odds of innovation in telehealth use in 2020, accounting for ED characteristics. Results: Of 4,038 EDs responding to telehealth questions in 2019 and 2020 (73% response rate), 3,015 used telehealth in 2020. Telehealth use by US EDs increased more than expected in 2020 (2016: 58%, 2017: 61%, 2018: 65%, 2019: 67%, 2020: 74%, greater than predicted 71%, p = 0.004). Existing telehealth infrastructure was associated with increased telehealth innovation (OR = 1.88, 95% CI: 1.49-2.36), whereas hospital system membership was not (odds ratio [OR] = 1.00, 95% confidence interval [CI]: 0.80-1.25). Conclusions: Telehealth use by US EDs in 2020 grew more than expected and preexisting telehealth infrastructure was associated with increased innovation in its use. Preparation for future pandemic responses may benefit from considering strategies to invest in local infrastructure to facilitate technology adoption and innovation.

Simplifying Hospital Quality Comparisons for Vascular Surgery Using Center-Level Frailty Burden Rather Than Comorbidities

Failure to rescue (FtR), or inpatient death following complication, is a publicly reported hospital quality measure. Previous work has demonstrated significant variation in the proportion of frail patients across hospitals. However, frailty is not incorporated into risk-adjustment algorithms for hospital quality comparisons and risk adjustment is made by comorbidity scores. Our aim was to assess the impact of frailty on FtR quality measurement and as a means of risk adjustment. Patients undergoing open or endovascular aneurysm repair or lower extremity bypass in the Vascular Quality Initiative (VQI) at centers performing ≥ 25 vascular procedures annually (2003-2019) were included. Multivariable logistic regression evaluated in-hospital death using scaled hierarchical modeling clustering at the center level. Center FtR observed/expected ratios were compared with expected values adjusted for either standard comorbidity profiles or frailty as measured by the VQI Risk Analysis Index. Centers were divided into quartiles using VQI-linked American Hospital Association data to describe the hospital characteristics of centers whose ranks changed. A total of 63,143 patients (213 centers) were included; 1,630 patients (2.58%) were classified as FtR. After accounting for center-level variability, frailty was associated with FtR [scaled odds ratio 1.9 (1.8-2.0), P<0.001]. The comorbidity-centric and frailty-based models performed similarly in predicting FtR with C-statistics of 0.85 (0.84-0.86) and 0.82 (0.82-0.84), respectively. Overall changes in ranking based on observed/expected ratios were not statistically significant (P=0.48). High and low performing centers had similar ranking using comorbidity-centric and frailty-based methods; however, centers in the middle of the performance spectrum saw more variability in ranking alterations. Forty nine (23%) of hospitals improved their ranking by five or more positions when using frailty versus comorbidity risk adjustment. The centers in Quartile 4, those who performed the highest number of vascular procedures annually, experience on average a significant improvement in hospital ranking when frailty was used for risk adjustment, whereas centers performing the fewest number of vascular procedures and the lowest proportion of vascular surgery cases annually (Quartile 1) saw a significant worsening of ranking position (all P<0.05). However, total number of surgical procedures annually, total hospital beds, for-profit status, and teaching hospital status were not significantly associated with changes in rank. A simple frailty-adjusted model has similar predictive abilities as a comorbidity-focused model for predicting a common quality metric that influences reimbursement. In addition to distilling the risk-adjustment algorithm to a few variables, frailty can be assessed preoperatively to develop quality improvement efforts for rescuing frail patients. Centers treating a greater proportion of frail patients and those who perform higher volumes of vascular surgery benefit from a risk adjustment strategy based on frailty.

Prevalence and County-Level Distribution of Births in Catholic Hospitals in the US in 2020

This study uses American Hospital Association data to examine the volume and distribution of births in Catholic US hospitals and quantify county-level patterns of Catholic and non-Catholic hospital births.

Assessment of Strategies Used in US Hospitals to Address Social Needs During the COVID-19 Pandemic

This survey study uses 2020 American Hospital Association data to assess strategies of US hospitals serving vulnerable populations in addressing social needs during the COVID-19 pandemic.

Evaluation of the American Hospital Association Annual Survey for health services research in emergency medicine.

ObjectivesEmergency department (ED) data are often used to address questions about access to and quality of emergency care. Our objective was to compare one of the most commonly used data sources for national ED information, the American Hospital Association (AHA) Annual Survey, with a criterion database: the National Emergency Department Inventory (NEDI)–USA data set.MethodsWe compared the 2015 and 2016 AHA surveys to the following 3 criterion standards: (1) the 2015 and 2016 NEDI‐USA databases, which have information about all US EDs, including merged data from (2) Council of Teaching Hospitals (COTH) and (3) the Critical Access Hospital (CAH) program. We present descriptive results about the number of EDs in each data set; total and median visit volumes; locations in rural areas; and COTH, CAH, and freestanding ED (FSED) status.ResultsThe AHA survey identified 3893 US EDs in 2015. These EDs had a total annual visit volume of 129,197,493 visits, with a median of 22,772 visits (interquartile range, 8311–47,938). Compared with the NEDI‐USA, the AHA included 1433 fewer EDs (−27%; 95% confidence interval [CI], −28% to −26%) and 23,615,163 (−15%) fewer visits. Specifically, AHA was missing 245 (−22%; 95% CI, −24% to −19%) of those located in rural areas, 268 (−20%; 95% CI, −22% to −18%) in a CAH, and 240 (−47%; 95% CI, −51% to −42%) FSEDs. We saw similar results using 2016 data.ConclusionsAlthough several aggregated results were similar between the compared data sources, the AHA data set excluded many US EDs, including many rural EDs and FSEDs. Consequently, the AHA underreported total ED visits by 15%. We encourage data users to be cautious when interpreting results from any 1 ED data source, including the AHA.

Hospital resource allocation decisions when market prices exceed Medicare prices.

To examine nonprofit hospitals' financial and spending allocations when the private sector payment rate is higher than the Medicare's payment rate. Hospital financial data for 2014-2018 from Center for Medicare and Medicaid Services Hospital Cost Reports, hospital characteristics from the American Hospital Association (AHA) Annual Survey. Hospital and year level fixed effects regressions modeling each hospital's (1) operating net income per discharge equivalent (DE); (2) administrative cost per DE; (3) patient care cost per DE; (4) registered nurse per bed; charity care cost per DE; and (5) provision of unprofitable services as a function of the private sector to Medicare payment ratio (PMR). Hospital/year-level data from hospital cost reports merged with AHA data. Samples included general short-term hospitals with nonprofit ownership, excluding critical access hospitals. The final sample included a total of 8862 hospital-year observations, with a mean PMR of 1.62. Nonprofit hospitals having a 0.1 higher PMR were associated with $257 (95% CI: $181-$334) increase in operating net income per DE; $66 (95% CI: $32-$99) increase in administrative cost per DE; $170 (95% CI: $120-$220) increase in patient care cost per DE; and $18 (95% CI: $10-$25) increase in charity care cost per DE. We found hospitals hired 0.86 (95% CI: -0.08 to 1.81) more registered nurses per 100 beds, but no evidence on providing more beds for unprofitable services, such as obstetric care, burn care, alcohol/drug abuse treatment, or psychiatric care. Higher private sector prices led primarily to greater surplus and administrative cost for nonprofit hospitals and smaller increases in spending on services that will directly benefit patients.

Birth Volume and Geographic Distribution of US Hospitals With Obstetric Services From 2010 to 2018

Timely access to clinically appropriate obstetric services is critical to the provision of high-quality perinatal care. To examine the geographic distribution, proximity, and urban adjacency of US obstetric hospitals by annual birth volume. This retrospective population-based cohort study identified US hospitals with obstetric services using the American Hospital Association (AHA) Annual Survey of Hospitals and Centers for Medicare & Medicaid provider of services data from 2010 to 2018. Obstetric hospitals with 10 or more births per year were included in the study. Data analysis was performed from November 6, 2020, to April 5, 2021. Hospital birth volume, defined by annual birth volume categories of 10 to 500, 501 to 1000, 1001 to 2000, and more than 2000 births. Outcomes assessed by birth volume category were percentage of births (from annual AHA data), number of hospitals, geographic distribution of hospitals among states, proximity between obstetric hospitals, and urban adjacency defined by urban influence codes, which classify counties by population size and adjacency to a metropolitan area. The study included 26 900 hospital-years of data from 3207 distinct US hospitals with obstetric services, reflecting 34 054 951 associated births. Most infants (19 327 487 [56.8%]) were born in hospitals with more than 2000 births/y, and 2 528 259 (7.4%) were born in low-volume (10-500 births/y) hospitals. More than one-third of obstetric hospitals (37.4%; 10 064 hospital-years) were low volume. A total of 46 states had obstetric hospitals in all volume categories. Among low-volume hospitals, 18.9% (1904 hospital-years) were not within 30 miles of any other obstetric hospital and 23.9% (2400 hospital-years) were within 30 miles of a hospital with more than 2000 deliveries/y. Isolated hospitals (those without another obstetric hospital within 30 miles) were more frequently low volume, with 58.4% (1112 hospital-years) located in noncore rural areas. In this cohort study, marked variations were found in birth volume, geographic distribution, proximity, and urban adjacency among US obstetric hospitals from 2010 to 2018. The findings related to geographic isolation and rural-urban distribution of low-volume obstetric hospitals suggest the need to balance proximity with volume to optimize effective referral and access to high-quality perinatal care.

PD13-09 ASSOCIATION OF HOSPITAL COMPETITION AND EFFICIENCY WITH DISPARITY IN QUALITY OF PROSTATE CANCER CARE

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History I (PD13)1 Sep 2021PD13-09 ASSOCIATION OF HOSPITAL COMPETITION AND EFFICIENCY WITH DISPARITY IN QUALITY OF PROSTATE CANCER CARE Ravishankar Jayadevappa, S. Bruce Malkowicz, J. Sanford Schwartz, and Sumedha Chhatre Ravishankar JayadevappaRavishankar Jayadevappa More articles by this author , S. Bruce MalkowiczS. Bruce Malkowicz More articles by this author , J. Sanford SchwartzJ. Sanford Schwartz More articles by this author , and Sumedha ChhatreSumedha Chhatre More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001989.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Hospital competition and efficiency can affect disparity in quality and cost of prostate cancer care. We examined the association of hospital competition and efficiency with process of care (time to and type of treatment, and overuse) and outcomes (medial care use, complications, mortality and cost) in Medicare enrollees with prostate cancer. METHODS: Study of Surveillance, Epidemiological, and End Results-Medicare data from 1995- 2016, linked with American Medical Association and American Hospital Association data. Cohort was prostate cancer patients aged ≥ 66 years. The Hirschman-Herfindahl index (HHI) was computed for all serving hospitals based on number of competitors. Overuse Index was used to measure overuse during treatment and follow-up phase. We computed hospital technical efficiency using data envelopment analysis. Outcomes were overall and prostate cancer-specific survival, readmissions, ER visits, and cost. We used survival analysis, competing risk analysis, Poisson models, and GLM (log-link) models. Multilevel models were used to address clustering. Propensity score and instrumental variable approaches were used to minimize potential biases. RESULTS: Of 434,264 patients, 85% had localized and 15% had advanced disease. Age, race/ethnicity, comorbidity, socio-economic status, and treatment differed by high vs. low hospital competition. Hospitals in high competition area were more likely to perform surgery, and those in low competition area used radiation therapy. In localized disease group, low competition was associated with higher hazard of overall (HR=1.08, 95% CI=1.07 - 1.10) and prostate cancer-specific mortality (HR=1.13, 95% CI=1.09 - 1.17) and higher odds of ER visits. Similar results were observed for the advanced stage group. Association between hospital efficiency and mortality varied by racial and ethnic groups. Higher hospital efficiency was associated with lower mortality, and ER admissions. CONCLUSIONS: Higher hospital competition is associated with improved quality of care and lower cost in prostate cancer care. Increasing hospital efficiency may reduce some of the disparity in prostate cancer outcomes. Racial and ethnic differences must be considered while planning hospital efficiency models. Policies to redirect minority patients to higher efficiency hospitals may reduce racial and ethnic disparity in quality of care and outcomes. Source of Funding: Agency for Healthcare and Research Quality 1R01HS024106-01 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e212-e213 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ravishankar Jayadevappa More articles by this author S. Bruce Malkowicz More articles by this author J. Sanford Schwartz More articles by this author Sumedha Chhatre More articles by this author Expand All Advertisement Loading ...

Longer time-to-treatment but better survival for colorectal cancer patients presumptively not diagnosed in a hospital.

To evaluate time-to-treatment and survival time in colorectal cancer (CRC) patients who presumptively were not diagnosed in a hospital. Colorectal tumor-level data from Georgia Cancer Registry (GCR) was merged with American Hospital Association data for 2010-2015 using hospital identification number. Patients with tumors lacking a diagnosis hospital in the GCR were classified as presumptive non-hospital diagnosis (PNHD). Cox proportional hazard models were used to model PNHD and time-to-treatment and time-to-death following cancer diagnosis, stratified by race and controlling for personal and tumor characteristics. PNHD (n = 6,885, 29.6%) was associated with a lower likelihood of treatment at a given point in time (i.e., longer time-to-treatment), but did not differ for Black (HR = 0.77, 95% CI: 0.73, 0.82) and White (HR = 0.73, 95% CI: 0.71, 0.76) patients. Time-to-death was longer (i.e., better survival) with PNHD, which also did not differ for Black (HR = 0.70, 95% CI: 0.64, 0.76) and White (HR = 0.71, 95% CI: 0.67, 0.75) patients. These results were not explained by confounding factors or differences in tumor stage at diagnosis. These observations warrant further research to understand whether there are potentially modifiable factors associated with the diagnosing location that can be used to benefit patient treatment trajectory and survival.

PCN140 Hospital Competition and Quality of Prostate Cancer Care

Hospital competition is important for addressing the variation in quality and cost. We examined the association of hospital competition with process of care (time to treatment, treatment type) and outcomes (mortality, emergency room (ER) use and cost) in Medicare fee-for-service beneficiaries with prostate cancer. This was a population-based cohort study of Surveillance, Epidemiological, and End Results (SEER)-Medicare data from 1995- 2016, linked with American Medical Association, and American Hospital Association data. Eligible patients were men aged ≥66 years with localized or advanced stage prostate cancer. Hirschman-Herfindahl index was computed for all serving hospitals based on number of competitors, i.e., number of hospitals situated within the hospital referral region. Outcomes were overall and prostate cancer-specific survival, ER visits, and cost. We used Cox proportional hazard models and competing risk models for assessing survival, Poisson models for count data, and GLM (log-link) models for cost data. Propensity score and instrumental variables were used to minimize potential biases. Of 434,264 patients, 85% were localized and 15% were advanced stage. Hospitals within high competition area were more likely to perform surgery, whereas those in low competition area used radiation therapy. Among localized disease patients, low hospital competition was associated with higher hazard of overall mortality (HR=1.08, 95% CI=1.07 - 1.10) and prostate cancer-specific mortality (HR=1.13, 95% CI=1.09 - 1.17), higher odds of ER visits (OR=1.13, 95% CI=1.11 - 1.15), and higher cost (OR=1.18, 95% CI=1.10 – 1.21). Similar results were observed for advanced stage patients. Higher scores on OI were associated with higher total medical costs per capita per year, and not associated with overall mortality. We observed that higher hospital competition is associated with improved quality of care and lower cost among patients with localized or advanced stage prostate cancer. Policy measures should be implemented to improve hospital competition.

Cost-Benefit Analysis of Robotic vs. Laparoscopic Hepatectomy: A Propensity-Matched Retrospective Cohort Study of American College of Surgeons National Surgical Quality Improvement Program Database.

Robotic and laparoscopic hepatectomies having increased utilization as minimally invasive techniques are explored for hepatobiliary malignancies. Although the data on outcomes from these 2 approaches are emerging, the cost-benefit analysis of these approaches remains sparse. This study compares the costs associated with robotic vs. laparoscopic liver resections, taking into account 30-day complications. Using the American College of Surgeons National Surgical Quality Improvement Program database, a propensity-matched cohort of patients with laparoscopic or robotic liver resections between 2014 and 2017 was identified. Costs were assigned to perioperative variables, including operating room (OR) time, length of stay, blood transfusions, and 30-day complications. Cost estimates were obtained from the Centers for Medicare and Medicaid Services billing data (2017), American Hospital Association data (2017), relevant literature, and local institutional cost data. In our matched cohort of 454 patients (227 per group), total costs associated with laparoscopic liver resections were estimated at $5.5M ($24K per patient) vs. $6.8M ($29.8K per patient) for robotic liver resections (21.3% difference, P < .001). The higher cost associated with robotic hepatectomies was related to blood transfusions ($22.0K vs. $12.1K, P = .02), length of stay ($2.05M vs. $1.76M, P = .046), and OR time ($4.01M vs. $3.24M, P < .0001). Robotic hepatectomies were associated with higher costs compared to laparoscopic hepatectomies. The 2 major contributors to the cost disparity were increased OR time and increased length of stay. Future studies are warranted to analyze high-volume Minimally Invasive Surgery surgeons' impact in specialty centers on potentially mitigating this current cost disparity.

Racial/Ethnic Disparities in Interhospital Transfer for Conditions With a Mortality Benefit to Transfer Among Patients With Medicare

Interhospital transfer (IHT) of patients is a common occurrence in modern health care. Racial/ethnic disparities are prevalent throughout US health care, but their presence in IHT is not well characterized. To determine if there are racial/ethnic disparities in IHT for medical diagnoses for which IHT is associated with a mortality benefit. This cross-sectional analysis used 2013 data from the Center for Medicare & Medicaid Services 100% Master Beneficiary Summary and Inpatient Claims merged with 2013 American Hospital Association data. Individuals with Medicare aged 65 years or older continuously enrolled in Medicare Part A and B with an inpatient hospitalization claim in 2013 for primary diagnosis of acute myocardial infarction, stroke, sepsis, or respiratory diseases were included. Data analysis occurred from November 2019 through July 2020. Race/ethnicity. The primary outcome of interest was IHT. For the primary analysis, a series of logistic regression models were created to estimate the adjusted odds of IHT for Black and Hispanic patients compared with White patients, controlling for patient clinical and demographic variables and incorporating hospital fixed effects. In secondary analyses, subgroup analyses were conducted by diagnosis, hospital teaching status, and hospitalization to hospitals in the top decile of Black and Hispanic patient proportion. Among 899 557 patients, 734 958 patients were White (81.7%), 84 544 patients were Black (9.4%), and 47 588 patients were Hispanic (5.3%); there were 418 683 men (46.5%), and 306 215 patients (34.0%) were older than 84 years. The mean (SD) age was 76.8 (7.5) years. Among all patients, 20 171 White patients (2.7%), 1913 Black patients (2.3%), and 1062 Hispanic patients (2.2%) underwent IHT. After controlling for patient variables and hospital fixed effects, Black patients had a persistently lower odds of IHT (adjusted odds ratio, 0.87; 95% CI, 0.81-0.92; P < .001), while Hispanic patients had higher odds of IHT (adjusted odds ratio, 1.14; 95% CI, 1.05-1.24; P = .002) compared with White patients. This national evaluation of IHT among patients hospitalized with diagnoses previously found to have mortality benefit with transfer found that, compared with White patients, Black patients had persistently lower adjusted odds of transfer after accounting for patient and hospital characteristics and measured across various hospital settings. Meanwhile, Hispanic patients had higher adjusted odds of transfer. This research highlights the need for the development of strategies to mitigate disparate transfer practices by patient race/ethnicity.

A comparison of medication access services at 340B and non-340B hospitals.

For patients that face barriers to filling their prescriptions, the availability of medication access services at their site of care can mean the difference between receiving prescribed drug therapy, and undue interruptions in care. Hospitals often provide medication access services that are not reimbursed by payers; however, they can be challenging to sustain. The 340B Drug Pricing Program allows covered entities to generate savings through discounted pricing for certain outpatient medications, which can then be used to provide more comprehensive services, including medication access services. To characterize medication access services provided at hospitals that participate in the 340B Drug Pricing Program compared to hospitals that do not participate in the 340B Program. Primary questionnaire response data was collected from a national sample of Directors of Pharmacy at non-federal acute care hospitals from March 2019 to May 2019. American Hospital Association Data Viewer was used to collect demographic information on 1,531 hospitals. Hospitals were excluded if they had 199 beds or fewer, did not have a unique Medicare provider ID, were federally owned, were located outside the continental U.S., or were non-acute care hospitals that served niche patient populations. This study utilized a proportional stratified sampling strategy to administer an electronic questionnaire to 340B and non-340B hospitals to assess the number and type of medication access service offerings. A final randomized sample of 500 hospitals were administered the questionnaire, and data was collected through recorded responses in Qualtrics software. 340B hospitals provided a significantly higher average number of medication access services compared to non-340B hospitals (6.20 vs. 3.91, p=0.0001), adjusted for differences in hospital size and ownership type. For all nine medication access services that were assessed, a higher percentage of 340B hospitals reported providing the service compared to non-340B hospitals. This difference was statistically significant for six out of nine programs assessed. 340B hospitals provided more medication access services, on average, than comparably sized non-340B hospitals, suggesting that hospitals participating in the 340B Drug Pricing Program may be better positioned to create and administer programs that support medication access services.

Hospital efficiency and quality of prostate cancer care.

223 Background: There is no consistent evidence with respect to the role of hospital efficiency in improving quality of prostate cancer care. Study objective was to examine the association between hospital efficiency and quality of care in African American, Hispanic, and white Medicare beneficiaries with prostate cancer. Methods: Population-based cohort study using Surveillance, Epidemiological, and End Results-Medicare (SEER-Medicare) data from 2000–2016 for prostate cancer patients aged 66 or older. SEER-Medicare data was linked to American Hospital Association data. We computed hospital technical efficiency using data envelopment analysis. Outcomes were emergency room visits, complications, hospitalizations, cost, treatment and mortality (all-cause and prostate cancer-specific). We used competing risk analysis for survival, log-link GLM models for cost, and Poisson (zero inflated) models for count data. Propensity score and instrumental variable approaches were used to minimize potential biases. Results: We identified 87,117 eligible prostate cancer patients. Of these, 86% were white, 11% were African American, and 3% were Hispanic. Table shows the association between four quartiles of efficiency and outcomes. Higher hospital efficiency was consistently associated with decreased all-cause mortality, prostate cancer-specific mortality and emergency room visits. Association between hospital efficiency and mortality varied between racial and ethnic groups. Conclusions: Increasing hospital efficiency may reduce some of the disparity in prostate cancer outcomes. Our findings indicate important racial and ethnic differences that should be considered while planning hospital efficiency models to improve quality of prostate cancer care. Policies to redirect minority patients to hospital with higher efficiency may reduce racial and ethnic disparity in quality of care and outcomes. [Table: see text]

Hospital characteristics associated with HIPAA breaches

ABSTRACT The avoidance of HIPAA breaches has been important to hospital administrators since 1996. Research has not provided insight into what strategies are most effective. The purpose of this paper is to identify the relationship between hospital organizational characteristics and specific types of HIPAA breaches (hacking, improper disposal, loss, theft, and unauthorized access/disclosure. We sought to better equip hospital administrators' to both assess their organization's relative risk for certain types of breaches. We propose, based on the sociotechnical approach that the occurrence of a HIPAA breach can be conceived as a misalignment between the social aspects of an organization and its technical capabilities. A purposive sample of hospitals with active HIPAA breach investigations (n = 163) is analyzed via a dataset that combines hospital characteristics from the American Hospital Association and HIPAA breach data from the Office of Civil Rights. The results of the analyses support the hypothesis of a relationship between hospital organizational characteristics and the types of HIPAA breaches, and most especially the influence of EMR capabilities, hospital size, system membership, and teaching status on various types of HIPAA Breach. This finding might assist healthcare leaders with proactively dealing with their organizational risks for HIPAA breaches.

Analysis of Hospital Resource Availability and COVID-19 Mortality Across the United States.

Although the impact of COVID-19 has varied greatly across the United States, there has been little assessment of hospital resources and mortality. We examine hospital resources and death counts among hospital referral regions from March 1 to July 26, 2020. This was an analysis of American Hospital Association data with COVID-19 data from the New York Times. Hospital-based resource availabilities were characterized per COVID-19 case. Death count was defined by monthly confirmed COVID-19 deaths. Geographic areas with fewer intensive care unit beds (incident rate ratio [IRR], 0.194; 95% CI, 0.076-0.491), nurses (IRR, 0.927; 95% CI, 0.888-0.967), and general medicine/surgical beds (IRR, 0.800; 95% CI, 0.696-0.920) per COVID-19 case were statistically significantly associated with an increased incidence rate of death in April 2020. This underscores the potential impact of innovative hospital capacity protocols and care models to create resource flexibility to limit system overload early in a pandemic.