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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.
The New England Journal of Medicine
|December 21, 1989
Summary
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.