County-Level Socioeconomic Status Adjustment of Acute Myocardial Infarction Mortality Hospital Performance Measure in...

Area of Science:

• Health Services Research
• Health Outcomes
• Health Equity

Background:

• The Centers for Medicare and Medicaid Services (CMS) Hospital Compare (HC) provides risk-adjusted hospital performance metrics.
• Current CMS risk adjustment does not account for socioeconomic status (SES), despite its association with health disparities.

Purpose of the Study:

• To explore the association between county-level SES factors and 30-day acute myocardial infarction (AMI) mortality rates.
• To assess the potential of SES factors for improving risk-adjustment models in hospital performance metrics.

Main Methods:

• Utilized data from 2,462 hospitals, incorporating various county-level SES data sources.
• Employed multiple imputation and a stepwise backward elimination model selection using Akaike's information criteria.

Main Results:

• A final model with 14 predictors, primarily at the county level, was identified.
• SES factors explained an additional 8% of the variability in 30-day risk-standardized AMI mortality rates, beyond clinical factors.

Conclusions:

• SES factors are significant predictors of AMI mortality and should be considered for inclusion in future CMS risk-adjustment models.
• Incorporating SES into risk adjustment has implications for resource distribution, such as reimbursements, and addressing health inequities.