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Quantifying Geographic Variation in Health Care Outcomes in the United States before and after Risk-Adjustment
Barry L Rosenberg1, Joshua A Kellar1, Anna Labno1
1The Boston Consulting Group, Boston, Massachusetts, United States of America.
Plos One
|December 16, 2016
Summary
Geographic variation in US health outcomes is substantial, even after adjusting for patient and system factors. These findings reveal significant opportunities for improving healthcare quality and patient safety across the nation.
Area of Science:
- Health Services Research
- Health Outcomes Research
- Geographic Health Disparities
Background:
- Limited comprehensive characterization of geographic variation in US health outcomes.
- Previous studies focused on healthcare costs and utilization, not outcomes.
- Need to quantify variation in an all-payer population before and after risk adjustment.
Purpose of the Study:
- To quantify geographic variation in US health outcomes.
- To compare variation across different geographic levels (state, region, county, hospital).
- To assess variation before and after risk adjustment for population, comorbidity, and health system factors.
Main Methods:
- Utilized 16 data sources and 22 million all-payer inpatient admissions (Healthcare Cost and Utilization Project).
- Analyzed 24 inpatient mortality, safety, and prevention outcomes.
- Calculated risk-adjusted outcomes considering population, comorbidity, and health system factors.
Main Results:
- Significant geographic variation in health outcomes exists, exceeding variation in healthcare costs.
- Observed 2.1-fold difference in risk-adjusted mortality and 10.2-fold difference in patient safety outcomes between top/bottom decile hospitals.
- Found 3.0-fold difference in prevention outcomes between top/bottom decile counties.
Conclusions:
- Substantial variability in US health outcomes persists even after risk adjustment.
- Highlights the need to examine regional/local outcome variations and challenge assumptions of uniform hospital quality.
- Indicates significant potential for healthcare quality and outcomes improvement nationwide.
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