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Hospital characteristics and mortality rates
A J Hartz1, H Krakauer, E M Kuhn
1Division of Biostatistics/Clinical Epidemiology, Medical College of Wisconsin, Milwaukee 53226.
Insights
Hospital ownership and teaching status significantly impact patient mortality rates. For-profit and public hospitals, along with osteopathic facilities, showed higher adjusted mortality rates compared to private, not-for-profit institutions.
Area of Science:
- Health Services Research
- Hospital Administration
- Public Health Policy
Background:
- Annual hospital mortality data is published by the Health Care Financing Administration (HCFA).
- Variations in hospital mortality rates exist and warrant investigation into associated hospital characteristics.
Purpose of the Study:
- To identify specific hospital characteristics linked to significant variations in adjusted mortality rates.
- To compare mortality rates across different hospital ownership types, teaching statuses, and resource allocations.
Main Methods:
- Utilized data from 3100 hospitals from the 1986 HCFA mortality study and the American Hospital Association's 1986 annual survey.
- Adjusted mortality rates for case mix and patient characteristics to enable fair comparisons.
- Compared mortality rates based on hospital ownership (for-profit, public, private not-for-profit), osteopathic status, teaching status, physician board certification, occupancy rates, payroll expenses, and registered nurse percentages.
Main Results:
- For-profit (121/1000) and public (120/1000) hospitals had higher adjusted mortality rates than private not-for-profit hospitals (114/1000).
- Osteopathic hospitals (129/1000) and private non-teaching hospitals (116/1000) also showed higher adjusted mortality rates.
- Private teaching hospitals had lower adjusted mortality rates (108/1000) compared to non-teaching hospitals.
- Hospitals with lower percentages of board-certified physicians, lower occupancy rates, lower payroll expenses per bed, and lower percentages of registered nurses had significantly higher mortality rates.
Conclusions:
- Hospital ownership, teaching status, and resource allocation are significant factors influencing patient mortality.
- Findings suggest that hospital characteristics play a crucial role in explaining variations in adjusted mortality rates.
- Policy implications may involve addressing disparities in care quality and resource distribution among different hospital types.
Abstract:
The Health Care Financing Administration (HCFA) publishes hospital mortality rates each year. We undertook a study to identify characteristics of hospitals associated with variations in these rates. To do so, we obtained data on 3100 hospitals from the 1986 HCFA mortality study and the American Hospital Association's 1986 annual survey of hospitals. The mortality rates were adjusted for each hospital's case mix and other characteristics of its patients. The mortality rate for all hospitalizations was 116 per 1000 patients. Adjusted mortality rates were significantly higher for for-profit hospitals (121 per 1000) and public hospitals (120 per 1000) than for private not-for-profit hospitals (114 per 1000; P less than 0.0001 for both comparisons). Osteopathic hospitals also had an adjusted mortality rate that was significantly higher than average (129 per 1000; P less than 0.0001). Private teaching hospitals had a significantly lower adjusted mortality rate (108 per 1000) than private nonteaching hospitals (116 per 1000; P less than 0.0001). Adjusted mortality rates were also compared for hospitals in the upper and lower fourths of the sample in terms of certain hospital characteristics. The mortality rates were 112 and 121 per 1000 for the hospitals in the upper and lower fourths, respectively, in terms of the percentage of physicians who were board-certified specialists (P less than 0.0001), 112 and 120 per 1000 for occupancy rate (P less than 0.0001), 113 and 120 per 1000 for payroll expenses per hospital bed (P less than 0.0001), and 113 and 119 per 1000 for the percentage of nurses who were registered (P less than 0.0001).