Differences In Hospital Characteristics Research Articles

Institutional Structures and Processes to Support Sepsis Care: A Multihospital Study

OBJECTIVES: To identify opportunities for improving hospital-based sepsis care and to inform an ongoing statewide quality improvement initiative in Michigan. DESIGN: Surveys on hospital sepsis processes, including a self-assessment of practices using a 3-point Likert scale, were administered to 51 hospitals participating in the Michigan Hospital Medicine Safety Consortium, a Collaborative Quality Initiative sponsored by Blue Cross Blue Shield of Michigan, at two time points (2020, 2022). Forty-eight hospitals also submitted sepsis protocols for structured review. SETTING: Multicenter quality improvement consortium. SUBJECTS: Fifty-one hospitals in Michigan. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the included hospitals, 92.2% (n = 47/51) were nonprofit, 88.2% (n = 45/51) urban, 11.8% (n = 6/51) rural, and 80.4% (n = 41/51) teaching hospitals. One hundred percent (n = 51/51) responded to the survey, and 94.1% (n = 48/51) provided a sepsis policy/protocol. All surveyed hospitals used at least one quality improvement approach, including audit/feedback (98.0%, n = 50/51) and/or clinician education (68.6%, n = 35/51). Protocols included the Sepsis-1 (18.8%, n = 9/48) or Sepsis-2 (31.3%, n = 15/48) definitions; none (n = 0/48) used Sepsis-3. All hospitals (n = 51/51) used at least one process to facilitate rapid sepsis treatment, including order sets (96.1%, n = 49/51) and/or stocking of commonly used antibiotics in at least one clinical setting (92.2%, n = 47/51). Treatment protocols included guidance on antimicrobial therapy (68.8%, n = 33/48), fluid resuscitation (70.8%, n = 34/48), and vasopressor administration (62.5%, n = 30/48). On self-assessment, hospitals reported the lowest scores for peridischarge practices, including screening for cognitive impairment (2.0%, n = 1/51 responded “we are good at this”) and providing anticipatory guidance (3.9%, n = 2/51). There were no meaningful associations of the Centers for Medicare and Medicaid Services’ Severe Sepsis and Septic Shock: Management Bundle performance with differences in hospital characteristics or sepsis policy document characteristics. CONCLUSIONS: Most hospitals used audit/feedback, order sets, and clinician education to facilitate sepsis care. Hospitals did not consistently incorporate organ dysfunction criteria into sepsis definitions. Existing processes focused on early recognition and treatment rather than recovery-based practices.

The Current State of High-Flow Nasal Cannula Protocols at Children's Hospitals.

To describe the current state of non-ICU high flow nasal cannula (HFNC) protocols at children's hospitals and explore associations between HFNC protocol type and utilization outcomes. We performed a cross-sectional study of the Pediatric Health Information Systems (PHIS) database. First, we designed a survey with the purpose of classifying HFNC protocols used at hospitals currently contributing data to PHIS. Next, we categorized hospitals based on their current HFNC protocol (ICU only, age-based non-ICU, or weight-based non-ICU). Finally, using the PHIS database, we compared hospital characteristics and patient-level bronchiolitis outcomes by HFNC protocol group. We received survey responses from 36 of 44 (82%) hospitals contributing data to PHIS in 2021. During the time period studied, there was a steady increase in adoption of non-ICU HFNC protocols, with 71% of responding children's hospitals reporting non-ICU HFNC protocols in 2021 compared with 11% before 2010. No differences in hospital characteristics were observed between ICU-only hospitals, age-based hospitals, or weight-based hospitals. Age-based hospitals had the highest proportion of bronchiolitis patients treated in the ICU (36.1%), whereas weight-based hospitals had the lowest proportion of patients treated in the ICU (21.0%, P < .001). Length of stay was longer at age-based hospitals (2.9 days) as compared with weight-based and ICU-only hospitals (1.9 days, P < .001). Most children's hospitals have adopted non-ICU HFNC protocols for patients with bronchiolitis, the majority of which are now utilizing weight-based maximum flow rates. Weight-based HFNC protocols were associated with decreased ICU utilization compared with age-based HFNC protocols.

Health disparities in regional anesthesia and analgesia for the management of acute pain in trauma patients.

Health disparities in regional anesthesia and analgesia for the management of acute pain in trauma patients.

Drug Testing Practices and Policies of Labor and Delivery Units Across the Southeastern United States

ObjectiveTo describe drug testing practices used in labor and delivery units in seven southeastern U.S. states (Alabama, Georgia, Florida, Mississippi, North Carolina, South Carolina, and Tennessee), determine what risk factors prompt drug testing, and determine whether selective policies or factors that prompt testing differ based on hospital characteristics (type, size, or predominant payer source). DesignCross-sectional descriptive design. SettingLabor and delivery units in seven southeastern U.S. states. ParticipantsNurse administrators of labor and delivery units (N = 49) who responded for their units. MethodsWe used a purposive sampling technique to construct a database of hospitals with obstetric services and e-mail addresses for nurse administrators. We created a 35-item survey to collect hospital characteristics and drug testing policy information. We distributed the survey to 291 nurse administrators. ResultsWe received 49 responses (response rate = 16.8%). Respondents reported that 63% (31/49) of hospitals were not-for-profit, 87% (40/46) had Medicaid as the predominant payer source, 80% (37/46) had a formal perinatal drug testing policy, and 61% (30/49) used selective drug testing protocols. Current or past history of substance use was reported as the risk factor that most often prompted drug testing. We did not find any differences in hospital characteristics (type, size, or predominant payer source) that prompted testing. ConclusionMost respondents reported that their labor and delivery units had a written drug testing policy and often used selective drug testing protocols. Drug testing protocols did not differ based on hospital type, size, or predominant payer source. Nurses have a role in implementing a best practice with unit-based drug testing.

Quality decreases from introducing patient choice in a National Health Service

A view often expressed about patient choice of health care providers is that it will increase competition between providers, which benefits the efficiency of the health system. We address here a patient choice initiative, regarding selection of hospital for specialty consultations, in the Portuguese National Health Service (NHS) that has two specific features. The first feature involves shared decision making between patients and GPs, in the choice of hospital for referral, which should be based on publicly available information on “quality”. The second specific feature is that the patient choice initiative did not involve payment changes to NHS hospitals associated with patients’ movements. We show that explaining initial asymmetries in qualities (waiting times) with systematic differences in hospital characteristics (cost advantages and managerial talent) leads to potential asymmetric responses to the introduction of patient choice in the NHS. This implies that the empirical analysis has to accommodate such asymmetries. Explicitly allowing for asymmetries in responses to the policy measure reveals that reactions were indeed different, with top-performance hospitals reducing their qualities (increasing waiting times) after the patient choice initiative was introduced.

Examining sources of post-acute care inequities with layered target matching.

To examine factors associated with racial inequities in discharge location, skilled nursing facility (SNF) utilization, and readmissions. A 20% sample of longitudinal Medicare claims from 2016 to 2018. We present layered target matching, a method for studying sources of inequities. Layered target matching examines a fixed target population profile representing any race, ethnicity, or vulnerable population, sequentially adjusting for sets of characteristics that may contribute to inequities these groups endure. We use the method to study racial inequities in post-acute care use and readmissions. We studied Black and non-Hispanic White fee-for-service Medicare beneficiaries aged 66+ admitted to short-term acute-care hospitals for qualifying diagnoses or procedures between January 1, 2016 and November 30, 2018. Admitted Black patients tended to be younger, had significantly higher rates of risk factors such as diabetes, stroke, or renal disease, and were much more frequently admitted to large or academic hospitals. Relative to demographically similar White patients, Black patients were significantly more likely to be discharged to SNFs (21.8% vs. 19.3%, difference=2.5%, p < 0.0001) and to receive any SNF care within 30 days of discharge (25.3% vs. 22.4%, difference=2.9%, p < 0.0001). Black patients were also significantly more likely to experience 30-day readmission (18.7% vs. 14.5%, difference=4.2%, p < 0.0001). Differences in reasons for hospitalization and risk factors explained most of the differences in discharge location, post-acute care use, and readmission rates, while additional adjustment for differences in hospital characteristics and complications made little difference for any of the measures studied. We found significant Black-White differences in discharge to SNFs, SNF utilization, and readmission rates. Using layered target matching, we found that differences in risk factors and reasons for hospitalization explained most of these differences, while differences in hospitals did not materially impact the differences.

Hospital Characteristics by Proportion of Patients from Disadvantaged Neighborhoods.

Neighborhood disadvantage reflects historic and ongoing systemic injustices. Without addressing these upstream social determinants of health, hospitals may face different risk profiles for important quality metrics. Our objective was to assess differences in hospital characteristics where the proportion of patients residing in severely disadvantaged neighborhoods was high vs low. Using Medicare fee-for-service claims between January 1, 2014 and November 30, 2014 (5,807,499 hospital stays), we calculated Area Disadvantage Share (ADS), the proportion of each hospital's discharges to severely disadvantaged neighborhoods, for 4,528 hospitals. We examined hospital characteristics by distribution of ADS and by risk-adjusted 30-day readmission. Hospitals in the highest decile cared for a higher proportion of Black patients, were more often located in rural areas, and had higher patient risk of 30-day readmission compared to all other deciles. Hospitals face unequal burdens of neighborhood disadvantage, a factor distinct from other social determinants such as rurality.

Regional disparity of certified teaching hospitals on physicians\u2019 workload and wages, and popularity among medical students in Japan

BackgroundRegional disparities in the working conditions of medical doctors have not been fully assessed in Japan. We aimed to clarify these differences in hospital characteristics: doctors’ workload, wages, and popularity among medical students by city population sizes.MethodsWe targeted 423 teaching hospitals certified by the Japanese Society of Internal Medicine and assessed the working conditions of physicians specializing in internal medicine. We calculated their workload (the annual number of discharged patients per physician) and retrieved data on junior residents’ monthly wages from the Resinavi Book which is popular among medical students in Japan to know the teaching hospital’s information and each hospital’s website. Furthermore, we explored the interim matching rate of each hospital as its popularity among medical students. Next, we classified cities in which all hospitals were located into eight groups based on their population size and compared the characteristics of these hospitals using a one-way analysis of variance.ResultsThe average workload was 110.3, while the average workload in hospitals located in most populated cities (≥ 2,000,000) was 88.4 (p < 0.05). The average monthly wage was 351,199 Japanese yen, while that in most populated cities was 305,635.1 Japanese yen. The average popularity (matching rate) was 101.9%, and the rate in most populated areas was 142.7%, which was significantly higher than in other areas.ConclusionsHospitals in most populated areas had significantly lower workloads and wages; however, they were more popular among medical students than those in other areas. This study was the first to quantify the regional disparities in physicians’ working conditions in Japan, and such disparities need to be corrected.

Smoke-Free Policies and 30-Day Mortality Rates for Chronic Obstructive Pulmonary Disease.

Smoke-free policies have been shown to impact 30-day readmission rates due to chronic obstructive pulmonary disease (COPD) among adults aged ≥65 years. However, little is known about the association between smokefree policies and 30-day mortality rates for COPD. Therefore, we investigated the association between comprehensive smoke-free policies and 30-day mortality rates for COPD. We used a cross-sectional study design and retrospectively examined risk-adjusted 30-day mortality rates for COPD across US hospitals in 1171 counties. Data were sourced from Centers for Medicare and Medicaid Services (CMS) Hospital Value-Based Purchasing (HVBP) Program, American Hospital Association (AHA) Annual Surveys, US Census Bureau Current Population Survey, and US Tobacco Control Laws Database from the American Nonsmokers' Rights Foundation (ANRF). Data were averaged at the county level for years 2015-2018. Hierarchical Poisson models adjusted for differences in hospital characteristics and accounted for the clustering of hospitals within a county were used. Our findings show a consistent association between stronger smoke-free policies and a reduction in COPD mortality. When evaluating smoke-free policy, county characteristics, and hospital characteristics individually, we found that counties with full coverage or partial coverage had a reduced incidence rate of COPD mortality compared to no coverage counties. After adjusting for the county and hospital characteristics, counties with full coverage of smoke-free policies had a reduced rate of 30-day COPD mortality (adjusted incidence rate ratio [IRR]: 0.87, 95% CI: 0.79, 0.96) compared to counties with no policy coverage. Comprehensive smoke-free policies are associated with a reduction in 30-day mortality following hospital admission for COPD. Partial smoke-free legislation is an insufficient preventative measure. These findings have strong implications for hospital policy-makers, suggesting that policy interventions to reduce COPD-related 30-day mortality should include implementing smoke-free policies and public health policy-makers to incentivize comprehensive smokefree policies.

Hospital Variation in 30-Day Readmissions Following Transcatheter Aortic Valve Replacement.

BackgroundData on hospital variation in 30‐day readmission rates after transcatheter aortic valve replacement (TAVR) are limited. Further, whether such variation is explained by differences in hospital characteristics and hospital practice patterns remains unknown.Methods and ResultsWe used the 2017 Nationwide Readmissions Database to identify hospitals that performed at least 5 TAVRs. Hierarchical logistic regression models were used to examine between‐hospital variation in 30‐day all‐cause risk‐standardized readmission rate (RSRR) after TAVR and to explore reasons underlying hospital variation in 30‐day RSRR. The study included 27 091 index TAVRs performed across 325 hospitals. The median (interquartile range) hospital‐level 30‐day RSRR was 11.9% (11.1%–12.8%) ranging from 8.8% to 16.5%. After adjusting for differences in patient characteristics, there was significant between‐hospital variation in 30‐day RSRR (hospital odds ratio, 1.59; 95% CI, 1.39–1.77). Differences in length of stay and discharge disposition accounted for 15% of the between‐hospital variance in RSRRs. There was no significant association between hospital characteristics and 30‐day readmission rates after TAVR. There was statistically significant but weak correlation between 30‐day RSRR after TAVR and that after surgical aortic valve replacement, percutaneous coronary intervention, acute myocardial infarction, heart failure, and pneumonia (r=0.132–0.298; P<0.001 for all). Causes of 30‐day readmission varied across hospitals, with noncardiac readmissions being more common at the bottom 5% hospitals (ie, those with the highest RSRRs).ConclusionsThere is significant variation in 30‐day RSRR after TAVR across hospitals that is not entirely explained by differences in patient or hospital characteristics as well as hospital‐wide practice patterns. Noncardiac readmissions are more common in hospitals with the highest RSRRs.

Disparities in hospital Capacities and Efficiency of Computer-based health insurance Claims Processing

Background. The Philippine Health Insurance Corporation (PhilHealth) has adopted several computer-based systems to enhance claims processing for hospitals.&#x0D; Objectives. This study sought to determine the efficiency gains in the processing of PhilHealth claims following the introduction of computer-based processing systems, taking into account differences in hospital characteristics.&#x0D; Methods. Data were obtained from a survey conducted among 200 hospitals, and their corresponding 2014 claims figures as provided by PhilHealth. Summary descriptive statistics of hospital capacities (ownership, service level, and utilization of PhilHealth computer systems) and claims outcomes (claims rejection rates, as well as length of claims processing times for hospitals and with PhilHealth) were generated. Multivariate regression analysis was done using claims outcomes as dependent variables, and hospital capacities as independent variables.&#x0D; Results. Nearly a quarter of the surveyed hospitals did not utilize any of PhilHealth’s computer-based claims systems. Utilization was lowest for primary as well as public facilities. Among those that used the systems, most employed the on-line membership verification program. The mean claims rejection rate was 3.81%. Claims processing by hospitals took an average of 35 days, while PhilHealth required 40 days from receipt of claims to release of reimbursement. Regression analysis indicated that facilities which utilized computers as well as private hospitals had significantly lower claims rejection rates (p&lt;0.05). The claims processing duration was significantly shorter among private facilities.&#x0D; Conclusions. Private hospitals are able to process claims and obtain reimbursements faster than public facilities, regardless of the use of PhilHeath’s computer-based systems. PhilHealth and public hospitals need to optimize claims processing arrangements.

Does Subclinical Hypothyroidism Affect Hospitalization Outcomes and Mortality in Congestive Cardiac Failure Patients?

ObjectiveThis study aimed to determine the differences in hospitalization outcomes among patients admitted for congestive cardiac failure (CCF) with underlying subclinical hypothyroidism (SCH).MethodsThis retrospective case-control study used data from the nationwide inpatient sample (NIS) for the years 2012–2014. We identified cases with CCF as the primary diagnosis and SCH as the secondary diagnosis using validated ICD-9-CM codes and controls with CCF only. The differences in hospitalization outcomes and hospital characteristics were quantified using the multinomial logistic regression model (adjusted odds ratio (aOR)).ResultsA total of 143,735 CCF patients were enrolled in this study, and 73,440 cases had IH. About 31.8% of SCH patients were hospitalized for more than four days (median) compared to 44.7% patients without SCH (P < .001). The median hospitalization charges per admission for CCF was $20,312. CCF patients with SCH had lower odds of longer hospitalization (aOR = .709, 95% CI .660-.762, P < .001) and higher hospitalization charges (aOR = .783, 95% CI .728-.841, P < .001) compared to CCF patients without SCH. CCF patients with SCH had two times higher odds of minor morbidity (aOR = 2.276; 95% CI 2.105-2.462; P < .001) but lower odds of major morbidity (aOR = .783; 95% CI .728-.841; P < .001). Inpatient mortality with SCH patients (2%) compared to 3.6% patients without SCH (P < .001). CCF patients with SCH had lower odds of in-hospital mortality (aOR = .547; 95% CI .496-.604; P < .001). CCF patients with SCH had higher odds of being seen in rural non-teaching hospitals (aOR = 1.696; 95% CI 1.572-1.831; P < .001). Also, CCF patients with SCH had the highest likelihood of presence in the western region of the United States (aOR = 149.924; 95% CI 110.497-203.419; P < .001) followed by the southern region (aOR = 31.431; 95% CI 26.066-37.900; P < .001).ConclusionsAmong CCF with SCH patients during hospitalization, we observed a variation in hospitalization outcomes, including inpatient length of stay and cost, morbidity, and in-hospital mortality. We found no significant increase in mortality and major morbidity in CCF patients with SCH. There were differences in the hospital characteristics between CCF patients with and without SCH. Thus, hospital bed size, location, and teaching status act as predictors for a co-diagnosis of SCH in CCF. Further research is needed to guide the development of clinical care models for targeting early diagnosis and treatment to determine whether thyroid hormone replacement would be beneficial for CCF patients with SCH and improve quality of care in these patients.

Trends and Disparities in Cervical Spine Fusion Procedures Utilization in the New York State.

A retrospective review of the Statewide Planning and Research Cooperative System database of the New York State. This study examined the rate of increase of cervical spine fusion procedures at low-, medium-, and high-volume hospitals, and analyzed racial and socioeconomic characteristics of the patient population treated at these three volume categories. There has been a steady increase in spinal fusion procedures performed each year in the United States, especially cervical and lumbar fusion. Our study aims to analyze the rate of increase at low-, medium-, and high-volume hospitals, and socioeconomic characteristics of the patient populations at these three volume categories. The New York State, Statewide Planning and Research Cooperative System (SPARCS) database was searched from 2005 to 2014 for the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Procedure Codes 81.01 (Fusion, atlas-axis), 81.02 (Fusion, anterior column, other cervical, anterior technique), and 81.03 (Fusion, posterior column, other cervical, posterior technique). Patients' primary diagnosis (ICD-9-CM), age, race/ethnicity, primary payment method, severity of illness, length of stay, hospital of operation were included. All 122 hospitals were categorized into high-, medium-, and low-volume. Trends in annual number of cervical spine fusion surgeries in each of the three hospital volume groups were reported using descriptive statistics. Low-volumes centers were more likely to be rural and non-teaching hospitals. African American patients comprised a greater portion of patients at low-volume hospitals, 15.1% versus 11.6% compared with high-volume hospitals. Medicaid and self-pay patients were also overrepresented at low-volume centers, 6.7% and 3.9% versus 2.6% and 1.7%, respectively. Compared with Caucasian patients, African American patients had higher rates of postoperative infection (P = 0.0020) and postoperative bleeding (P = 0.0044). Compared with privately insured patients, Medicaid patients had a higher rate of postoperative bleeding (P = 0.0266) and in-hospital mortality (P = 0.0031). Our results showed significant differences in hospital characteristics, racial distribution, and primary payments methods between the low- and high-volume categories. African American and Medicaid patients had higher rates of postoperative bleeding, despite similar rates between the three volume categories. This suggests racial and socioeconomic disparities remains problematic for disadvantaged populations, some of which may be attributed to accessibility to care at high-volume centers. 3.

Trends in Regionalization of Care for ST-Segment Elevation Myocardial Infarction.

IntroductionCalifornia has led successful regionalized efforts for several time-critical medical conditions, including ST-segment elevation myocardial infarction (STEMI), but no specific mandated protocols exist to define regionalization of care. We aimed to study the trends in regionalization of care for STEMI patients in the state of California and to examine the differences in patient demographic, hospital, and county trends.MethodsUsing survey responses collected from all California emergency medical services (EMS) agencies, we developed four categories – no, partial, substantial, and complete regionalization – to capture prehospital and inter-hospital components of regionalization in each EMS agency’s jurisdiction between 2005–2014. We linked the survey responses to 2006 California non-public hospital discharge data to study the patient distribution at baseline.ResultsSTEMI regionalization-of-care networks steadily developed across California. Only 14% of counties were regionalized in 2006, accounting for 42% of California’s STEMI patient population, but over half of these counties, representing 86% of California’s STEMI patient population, reached complete regionalization in 2014. We did not find any dramatic differences in underlying patient characteristics based on regionalization status; however, differences in hospital characteristics were relatively substantial.ConclusionPotential barriers to achieving regionalization included competition, hospital ownership, population density, and financial challenges. Minimal differences in patient characteristics can establish that patient differences unlikely played any role in influencing earlier or later regionalization and can provide a framework for future analyses evaluating the impact of regionalization on patient outcomes.

655: Variation in cesarean delivery rates among high-risk pregnancies across hospitals in the U.S

The rate of cesarean deliveries in the U.S. has peaked in the last decade, now reaching a level over double the upper limit deemed acceptable by the WHO. Studies have also described large unexplained variation in cesarean delivery rates between countries, states, hospitals, and physicians. Our study aims to evaluate the current variation in cesarean delivery rates between hospitals across the U.S., and to evaluate differences in hospital characteristics and high-risk pregnancy factors that could explain the higher cesarean delivery rates seen in certain hospitals. We conducted a retrospective population-based cohort study using the 2011 HCUP-NIS database. We identified all U.S. hospitals with delivery admissions and compared the hospitals with high cesarean delivery rates to those with low/mid rates, in terms of hospital and maternal characteristics, as well as neonatal and maternal outcomes. We used stratified regression to further evaluate the independent impact of each hospital characteristic and pregnancy high-risk factor on the observed disparity in cesarean delivery rates. The cesarean delivery rate in the U.S. rose steadily from 29% in 2003 to 34% in 2012. In 2011, 99% of U.S. hospitals have a cesarean delivery rate beyond 20%. The disparity in cesarean delivery rates between high and low-cesarean-delivery-rate hospitals remained after stratifying by individual hospital characteristics and individual pregnancy risk factor. Specifically, the likelihood of having a cesarean delivery in a woman with a high-risk pregnancy is two-fold (aOR 1.99, CI 1.92-2.06) if she is cared for in a hospital within the high-cesarean-delivery-rate group than in one within the low/mid-cesarean-delivery-rate group. Meanwhile, we found no significant difference in neonatal outcomes or maternal outcomes between patients delivered in a high vs. low-cesarean-delivery-rate hospital. Individual hospitals are in themselves independent risk factors for cesarean delivery, regardless of hospital location, payment source, teaching status and bed size, and regardless of patients’ pregnancy risks and characteristics. Choosing to give birth in a certain hospital can put patients at a two-fold risk of having a cesarean delivery, without benefits in maternal or neonatal outcomes.

A Comparison of Drug Shortages in the Hospital Setting in the United States and Saudi Arabia: An Exploratory Analysis.

Drug shortages are a problem that has been growing in recent years. This problem has an impact on patient outcomes and public health. Most countries have been affected by a diversity of drug supply chain problems. To assess explanations for differences in drug shortages reported in the hospital setting in Saudi Arabia (SA) and the United States (US). Data were collected in May-June 2014 from Brigham and Women's Hospital (BWH) and from 2 Saudi hospitals: King Abdulaziz University Hospital (KAUH) and King Faisal Specialist Hospital and Research Centre (KFSHRC). Drugs were classified using the World Health Organization (WHO) Anatomical Therapeutic Chemical (ATC) classification system. The drug shortages among the hospitals were compared using descriptive statistics and a chi-square test. The percentage of the total number of active ingredients reported in shortage was higher in the US hospital setting (15.1%) than in the Saudi hospitals (10.3%) (p < .0001). KAUH reported the highest number of shortages (n = 133), followed by BWH (n = 42) and KFSHRC (n = 27). A significantly higher percentage of shortages involved injectable drugs in the US hospital setting (78.1%) than the Saudi hospitals (34.43%) (p ≤ .0001). Nervous system (17%) and alimentary tract and metabolism agents (15.7%) were the therapeutic areas with the higher number of reported shortages in the US and SA hospital settings, respectively. The number and characteristics of shortages varied by country and hospital. Several factors, including differences in hospital characteristics, number and type of drugs available, and procurement systems, may explain differences in reported shortages.

Benchmarking Glycemic Control In U.S. Hospitals

Report data on glucose control from 635 U.S. hospitals. Point-of-care blood glucose (POC-BG) test data from January through December 2012 from 635 facilities were extracted. Glucose control was evaluated using patient-day-weighted mean POC-BG values. We calculated hypoglycemia and hyperglycemia rates, stratified by presence or absence of intensive care unit (ICU) admission, and we evaluated the relationship between glycemic control and hospital characteristics. In total, 51,375,764 POC-BG measurements (non-ICU, 39,197,762; ICU, 12,178,002) from 2,612,966 patients (non-ICU, 2,415,209; ICU, 575,084) were analyzed. The mean POC-BG was 167 mg/dL for non-ICU patients and 170 mg/dL for ICU patients. The prevalence of hyperglycemia (defined as glucose value >180 mg/dL) was 32.3 and 28.2% in non-ICU and ICU patients, respectively. The prevalence of hypoglycemia (defined as glucose value <70 mg/dL) was 6.1 and 5.6% in non-ICU and ICU patients, respectively. In non-ICU and ICU settings, the patient-day-weighted mean glucose was highest in the smallest hospitals, in rural hospitals, and in hospitals located in the Northeast (all P<.01). For non-ICU patients, we observed a significant difference in the percentage of patient days with hypoglycemia by geographic region only (P<.001). In ICU patients, the prevalence of hypoglycemia varied significantly by hospital type (P<.03) and geographic region (P<.01). In this largest POC-BG data set analysis conducted to date, glycemic control varied according to hospital characteristics. Our findings remain consistent with previous reports. Among other variables, national benchmarking of inpatient glucose data will need to consider differences in hospital characteristics.

Evaluating the quality of in-hospital stroke care, using an opportunity-based composite measure: a multilevel approach

Evaluating the quality of in-hospital stroke care, using an opportunity-based composite measure: a multilevel approach Aida Ribera,1&ndash;3 S&ograve;nia Abilleira,1,3 Gaiet&agrave; Permanyer-Miralda,2,3 Ricard Tresserras,4 Joan MV Pons,1,3 Miquel Gallofr&eacute;3,4 1Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain; 2Cardiovascular Epidemiology Unit, Hospital Vall d&#39;Hebron, Barcelona, Spain; 3CIBER Epidemiolog&iacute;a y Salud P&uacute;blica, Madrid, Spain; 4Stroke Program, Department of Health, Autonomous Government of Catalonia, Barcelona, Spain Background: Development of process-based quality measures has been of increasing interest. We aimed to construct a composite quality measure for acute stroke care and to evaluate its performance at the hospital level. Methods: We used data from the Stroke Audit 2007, based on retrospective review of medical charts linked to the Mortality Register 2007&ndash;2008 (Catalonia, Spain). Eight quality measures were selected on the basis of clinical relevance, scientific evidence, and relationship to mortality: screening of dysphagia, initiation of antiplatelets at less than 48 hours (if ischemic stroke), early mobilization, assessment of rehabilitation, management of hypertension, management of dyslipidemia, anticoagulation in case of atrial fibrillation (if ischemic stroke), and antithrombotics on discharge (ischemic strokes only). We constructed an opportunity-based composite quality measure of eight individual measures and correlated noncompliance with the individual and composite quality measures with risk-standardized 30-day mortality at the hospital level. Noncompliance with the opportunity-based composite measure was calculated as the sum of the total instances that a required individual measure was not performed or not documented. Multilevel linear regression analyses were conducted to assess the variability of noncompliance at the hospital level and to what extent variability could be explained by differences in hospital characteristics. Results: We analyzed data from 1,686 patients (representing 9,334 opportunities for compliance with the composite quality measure) admitted to 47 acute hospitals. Noncompliance with the composite was 32.7% (95% confidence interval [CI], 31.5%&ndash;33.9%), and the correlation with hospital risk-adjusted 30-day mortality was 0.24 (P=0.1). Using multilevel logistic modeling, hospitals with an intermediate number of annual stroke admissions (150&ndash;350 versus &lt;150) and hospitals with an ongoing stroke registry showed better compliances (odds ratio for noncompliance, 0.59 [95% CI, 0.4&ndash;0.87] and 0.5 [95% CI, 0.35&ndash;0.73], respectively). Individual factors explained 3.9% of hospital variability, whereas structural variables explained 49.4% of hospital variability. Conclusion: An opportunity-based composite may be useful to globally assess quality of stroke care across providers, even though correlations with mortality are weak. In addition, it offers new insights about the relationship between hospitals&#39; structural resources and quality. Keywords: acute stroke care, composite quality measure, multilevel analysis

Outcomes for Whites and Blacks at Hospitals That Disproportionately Care for Black Medicare Beneficiaries

Hospital care for blacks is concentrated among a small number of hospitals and whether they have worse outcomes across common medical conditions is unknown. We used the 2007 100% Medicare file to calculate 30- and 90-day mortality rates for white and black patients admitted for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia. We ranked all hospitals in the country by their proportion of discharged black patients and identified the top 10 percent of these hospitals as black serving. We examined race-specific adjusted mortality rates and adjusted for differences in hospital characteristics. At 30 days, black-serving hospitals had, compared with nonblack-serving hospitals, similar mortality for AMI, lower mortality for CHF, and higher mortality for pneumonia. At 90 days, mortality was higher at black-serving hospitals for both AMI and pneumonia and comparable for CHF compared with nonblack-serving hospitals. White patients had worse outcomes at black-serving hospitals for two conditions at 30 days and all three conditions at 90 days. Blacks also had worse outcomes at black-serving hospitals. Hospitals with a high proportion of black patients had worse outcomes than other hospitals for both their white and black elderly patients.

Abstract P269: Linkage of Patients in a National Heart Failure Clinical Registry to Medicare Claims Data: An Analysis of Generalizability and Longitudinal Outcomes from ADHERE

Background: Registries are increasingly being used to analyze quality, outcomes, and clinical effectiveness in HF patients. The degree to which registry patients reflect the population of real-world HF patients is unclear. Methods: We linked data from the Acute Decompensated Heart Failure National Registry (ADHERE) to Medicare claims. We compared patient characteristics and inpatient mortality of ADHERE hospitalizations linked to Medicare, with ADHERE hospitalizations not linked to Medicare. We also compared patient characteristics, 1-year readmission, inpatient mortality, and 1-year mortality of linked ADHERE patients to a 20% sample of Medicare patients hospitalized for HF. Hospital characteristics among Medicare sites participating and not participating in ADHERE were also compared. Results: Among 135,667 ADHERE hospitalizations for HF patients ≥ 65 years, we linked 104,808 (77.3%) to Medicare claims, representing 82,074 unique patients. Within ADHERE, Medicare-linked hospitalizations were more likely to involve patients who were female and white, but there were no clinically relevant differences in other patient characteristics. In-hospital mortality was identical for ADHERE hospitalizations linked and not linked to Medicare (4.5%). ADHERE hospitals were more likely than non-ADHERE hospitals to be teaching hospitals, to have a higher volume of HF patients, and to offer advanced cardiac care. Within Medicare, ADHERE patients and non-ADHERE patients had similar demographics and comorbidities. ADHERE patients had slightly lower observed mortality and readmission rates (Table). After risk adjustment, modest but statistically significant differences remained. Conclusion: There is a high degree of similarity between ADHERE patients and Medicare patients hospitalized with HF. While there are differences in hospital characteristics, ADHERE data are representative of the real-world elderly HF population. Mortality/readmission outcomes for ADHERE and non-ADHERE Medicare patients hospitalized with HF Outcomes variable Patients within Medicare Non-ADHERE (N=571,649) ADHERE (N=79,508) 1 P-value 2 Adjusted OR/HR (95% CI) 3 Mortality, In-hospital 27,779 (4.9%) 3,516 (4.4%) &lt;.001 0.94 (0.90-0.97) Mortality, 1-year 218,703 (38.3%) 28,579 (36.0%) &lt;.001 0.95 (0.94, 0.96) Readmission, 1-year all-cause 4 349,990 (67.9%) 48,802 (65.8%) &lt;.001 0.94 (0.93, 0.94) Readmission, 1-year cardiovascular 3 223,430 (43.4%) 31,553 (42.6%) &lt;.001 0.96 (0.95, 0.97) 1 Total number of unique, linked ADHERE patients with 1 year prior claims eligible for analysis 2 P-values based on chi-square tests stratified by discharge year 3 In-hospital mortality results shown as odds ratios (OR); all other results shown as hazard ratios (HR) 4 Among patients eligible for readmission analysis (N=518,548 Non-ADHERE patients; N=74,450 ADHERE patients)