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Impact of Hospital Safety-Net Burden on Outcomes of In-Hospital Cardiac Arrest in the United States
Titilope Olanipekun1,2, Temidayo Abe2,3, Abimbola Chris-Olaiya4
1Department of Hospital Medicine, Covenant Health System, Knoxville, TN.
Insights
Patients experiencing in-hospital cardiac arrest (IHCA) at high safety-net burden hospitals (HBHs) have lower survival rates. These findings highlight disparities in care and outcomes for vulnerable patient populations, emphasizing the need for targeted interventions.
Area of Science:
- Cardiology
- Health Services Research
- Health Disparities
Background:
- High safety-net burden hospitals (HBHs) serve populations with high rates of uninsured or Medicaid-insured patients.
- Previous research links HBHs to poorer clinical outcomes, but data on in-hospital cardiac arrest (IHCA) is limited.
- Understanding IHCA outcomes in HBHs is crucial for addressing healthcare disparities.
Purpose of the Study:
- To compare survival to discharge and routine home discharge rates between patients experiencing IHCA at HBHs versus low safety-net burden hospitals (LBHs).
- To analyze healthcare resource utilization, including length of stay and total hospitalization costs, for IHCA patients at HBHs compared to LBHs.
Main Methods:
- Retrospective cohort study utilizing the Nationwide Inpatient Database (2008-2018).
- Included hospitalized patients aged 18+ who underwent cardiopulmonary resuscitation (CPR) for IHCA.
- Multivariate analysis was performed to adjust for patient and hospital characteristics.
Main Results:
- Over 555,000 IHCA cases were analyzed; 55.2% occurred at HBHs.
- Patients at HBHs were younger, had lower median household incomes, and experienced lower survival to discharge (aOR, 0.88) and routine home discharge (aOR, 0.6) compared to LBHs.
- Publicly owned hospitals, larger hospital bed sizes, and lower median household income were associated with decreased survival.
Conclusions:
- IHCA patients treated at HBHs demonstrate significantly lower odds of survival and routine discharge post-CPR.
- Factors such as median household income and hospital characteristics significantly influence IHCA survival rates.
- Findings underscore disparities in cardiac arrest care and outcomes based on hospital safety-net burden and socioeconomic factors.
Abstract:
High safety-net burden hospitals (HBHs) treating large numbers of uninsured or Medicaid-insured patients have generally been linked to worse clinical outcomes. However, limited data exist on the impact of the hospitals' safety-net burden on in-hospital cardiac arrest (IHCA) outcomes in the United States.
Objectives:
To compare the differences in survival to discharge, routine discharge home, and healthcare resource utilization between patients at HBH with those treated at low safety-net burden hospital (LBH).
Design Setting And Participants:
Retrospective cohort study across hospitals in the United States: Hospitalized patients greater than or equal to 18 years that underwent cardiopulmonary resuscitation (CPR) between 2008 and 2018 identified from the Nationwide Inpatient Database. Data analysis was conducted in January 2022.
Exposure:
IHCA.
Main Outcomes And Measures:
The primary outcome is survival to hospital discharge. Other outcomes are routine discharge home among survivors, length of hospital stay, and total hospitalization cost.
Results:
From 2008 to 2018, an estimated 555,016 patients were hospitalized with IHCA, of which 19.2% occurred at LBH and 55.2% at HBH. Compared with LBH, patients at HBH were younger (62 ± 20 yr vs 67 ± 17 yr) and predominantly in the lowest median household income (< 25th percentile). In multivariate analysis, HBH was associated with lower chances of survival to hospital discharge (adjusted odds ratio [aOR], 0.88; 95% CI, 0.85-0.96) and lower odds of routine discharge (aOR, 0.6; 95% CI, 0.47-0.75), compared with LBH. In addition, IHCA patients at publicly owned hospitals and those with medium and large hospital bed size were less likely to survive to hospital discharge, while patients with median household income greater than 25th percentile had better odds of hospital survival.
Conclusions And Relevance:
Our study suggests that patients who experience IHCA at HBH may have lower rates and odds of in-hospital survival and are less likely to be routinely discharged home after CPR. Median household income and hospital-level characteristics appear to contribute to survival.
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