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Comparing outcomes and charges for patients with acute myocardial infarction in three community hospitals: an
E C Nelson1, S Greenfield, R D Hays
1Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
Insights
Hospital care value for acute myocardial infarction (Acute MI) patients varied significantly across three community hospitals. After adjusting for patient differences, one hospital excelled in patient outcomes, while another was more cost-effective.
Area of Science:
- Healthcare research
- Quality improvement science
- Health services research
Background:
- Assessing healthcare value requires comparing patient outcomes against healthcare costs.
- Acute myocardial infarction (Acute MI) patient care quality can differ across healthcare facilities.
- Patient mix variations can complicate direct comparisons of hospital performance.
Purpose of the Study:
- To evaluate the value of care for acute myocardial infarction (Acute MI) patients across three community hospitals.
- To adjust for patient mix differences when comparing outcomes and charges.
- To determine how hospital characteristics influence patient outcomes and resource utilization.
Main Methods:
- An observational cohort study of 133 non-transfer Acute MI patients from three southeastern US community hospitals.
- Data collection included medical record review and 8-week post-discharge patient questionnaires.
- Outcomes (clinical, functional, satisfaction) and resource intensity (LOS, charges) were analyzed, adjusted for severity, comorbidity, and demographics.
Main Results:
- Significant patient mix differences existed, with Hospital C having higher comorbidity than Hospital B.
- After adjustments, Hospital C demonstrated superior outcomes in angina, dyspnea, and physical/psychosocial functioning.
- Hospital A showed lower resource intensity (length of stay, charges) compared to Hospitals B and C.
Conclusions:
- Healthcare value profiles for Acute MI care varied substantially among the studied hospitals.
- Simultaneous measurement of outcomes, costs, and patient mix can guide clinical teams in improving care value.
- Such comprehensive data can empower purchasers to make informed provider selections.
Objective:
To assess the value of care (i.e. outcomes in relation to charges) for acute myocardial infarction (Acute MI) patients in three community hospitals after controlling for patient mix differences.
Design:
An observational study of a cohort of acute MI patients admitted to hospital for care were studied based on medical record review and on patient-completed questionnaires at 8 weeks post-discharge.
Setting:
Three community hospitals located in urban areas in the southeastern region of the United States.
Patients:
A consecutive sample of 133 non-transfer Acute MI patients were entered into the study based on EKG results, enzyme tests and chest pain characteristics. Hospital medical record and charge data were available on all patients and patient-reports on 86% of survivors.
Main Outcome Measures:
Data were gathered on clinical outcomes (death, angina, dyspnea), functional outcomes (physical and psychosocial), satisfaction, and resource intensity (length of stay, total hospital charges, ancillary charges). Because of patient mix differences across hospitals, outcomes were adjusted for severity of Acute MI, comorbidity and demographics.
Results:
There were important patient mix differences across hospitals. For example, Hospital C had more comorbidity than Hospital B (57.78% of Hospital C patients vs 15.00% of Hospital B patients were rated moderate or severe using a well tested index, p < 0.0001). After adjusting for patient mix differences, Hospital C scored significantly better on four of six outcome measures (i.e. angina, dyspnea, physical functioning, psychosocial functioning). For example, Hospital C's patients' mean scores on physical functioning at 8 week follow-up averaged 75.19 (on a 0-100 scale), while Hospital A's was 63.03 and Hospital B's was 48.57 (F-ratio = 4.95; p < 0.05). However, Hospital A scored significantly lower on all three resource intensity indicators (length of stay, ancillary charges, and total charges). For example, Hospital A's ancillary charges averaged $10,752 while Hospital B's and C's averaged $11,432 and $16,598 respectively. Between-hospital comparisons on adjusted mortality and satisfaction did not differ significantly.
Conclusion:
The "value" profiles (i.e. outcomes related to charges) produced by these three hospitals were substantially different. Studies that simultaneously measure outcomes, costs, patient mix and processes have potential to: (a) enable clinical teams to improve the measurable value of clinical care; and (b) enable purchasers to better evaluate which providers to select as preferred sources of care.