State-Level Hospital Quality in the United States: Analyzing Variation and Trends From 2013 to 2021

Area of Science:

• Health Services Research
• Healthcare Quality Improvement
• Health Policy Analysis

Background:

• Significant variations exist in hospital quality across U.S. states.
• Monitoring and analyzing these variations is crucial for healthcare policy and patient outcomes.
• Existing metrics may not fully capture the multifaceted nature of hospital quality.

Purpose of the Study:

• To develop and apply a composite hospital quality index to assess state-level variations in U.S. hospital quality.
• To analyze trends in hospital quality from 2013 to 2021.
• To identify high-performing and underperforming states regarding hospital quality.

Main Methods:

• A hospital quality index was developed using Centers for Medicare & Medicaid Services (CMS) Hospital Compare data for approximately 3,000 U.S. hospitals.
• The index integrated three risk-adjusted measures: 30-day readmission rates, 30-day mortality rates, and patient experience scores.
• Measures were converted to z-scores, weighted by hospital bed count, and averaged to create a standardized index (mean=0, SD=1).

Main Results:

• In 2021, average U.S. hospital quality metrics were 15.1% for readmissions, 11.2% for mortality, and 69.7% for patient experience.
• Significant state-level heterogeneity in hospital quality was observed, with the index ranging from -0.54 to 0.57.
• Eight states, led by Utah, outperformed the U.S. average, while 14 states underperformed. Annual improvements in readmissions and mortality were noted, but patient experience declined.

Conclusions:

• Hospital quality in the U.S. has shown improvements over the study period, particularly in reducing readmissions and mortality.
• Substantial disparities in hospital quality persist at the state level, indicating uneven healthcare delivery.
• The developed hospital quality index serves as a valuable tool for understanding, monitoring, and addressing variations in hospital care quality across states.