Treatment by a cardiologist is associated with approximately a 17% reduction in hospital mortality in acute myocardial infarction patients. In addition, patients of physicians treating a high volume of patients have approximately an 11% reduction in mortality. This has important implications for the optimal treatment of acute myocardial infarction in the current transformation of the health care delivery system.
It is unclear whether public reporting of hospital and physician performance has improved outcomes for the conditions being reported. We studied the effect of intensive public reporting on hospital mortality for 6 high-frequency, high-mortality medical conditions. Patients in Pennsylvania were matched to patients in other states with varying public reporting environments using propensity score methods. The effect of public reporting was estimated using a difference in differences approach. Patients treated at hospitals subjected to intensive public reporting had significantly lower odds of in-hospital mortality when compared with similar patients treated at hospitals in environments with no public reporting or only limited reporting. Overall, the 2000-2003 in-hospital mortality odds ratio for Pennsylvania patients versus non-Pennsylvania patients ranged from 0.59 to 0.79 across 6 clinical conditions (all P < .0001). For the same comparison using the 1997-1999 period, odds ratios ranged from 0.72 to 0.90, suggesting improvement when intensive public reporting occurred.
OBJECTIVES. To compare county rates of hospital admissions for pediatric pneumonia and to assess the contribution of comorbid chronic conditions to county and state pediatric pneumonia admission rates.
METHODS. We performed retrospective analyses of data for all Pennsylvania-resident children 2 months through 17 years of age who were admitted to acute care hospitals with a principal diagnosis of pneumonia in 2003 or 2004. We divided the admissions into 2 groups (all pneumonia and pneumonia excluding coded comorbid chronic conditions) and calculated admission rates for each Pennsylvania county.
RESULTS. There were 5429 pediatric pneumonia admissions during the 12-month study period, of which 4948 (91.1%) were included in the study. The Pennsylvania state admission rate for all pneumonia was 156.3 admissions per 100000 children. County admission rates for all pneumonia ranged from 77.0 admissions per 100000 children to 457.6 admissions per 100000 children. Similar geographic patterns were seen among the 2851 admissions that remained in the second group after the exclusion of 2097 records (42.4%) coded for comorbid chronic conditions. The Pennsylvania state admission rate for pneumonia without chronic conditions was 90.0 admissions per 100000 children. County admission rates for pneumonia without comorbid chronic conditions ranged from 18.3 admissions per 100000 children to 350.3 admissions per 100000 children. Sixty-two (93%) of 67 counties remained in the same or an adjacent admission rate quintile after children with comorbid chronic conditions were excluded. On average, the county admission rates for pneumonia without comorbid chronic conditions were 58.1% of their admission rates for all pneumonia.
Conclusions. County pediatric pneumonia admission rates vary widely, even among geographically contiguous and demographically similar counties. Excluding children with comorbid chronic conditions, to control for varying community disease burdens, did not alter substantially the county rank order or the pattern or degree of variations in admission rates in our study.
Two recent changes in Philadelphia-area hospital organizations are consolidation into systems and acquisition of 2 medical school hospitals by a for-profit chain. This study explored whether such consolidation and conversion affected costs and outcomes of care. The analysis included 1,617,581 discharges from 49 acute-care hospitals from 1997 to 1999. Analyses within and between medical school hospitals examined trends in discharges, case mix, length of stay, and mortality. The study addressed 2 questions: whether, as hospitals consolidate into medical school hospital-based systems, volume, severity, length of stay, and mortality increase in those hospitals; and whether for-profit conversion redistributes complex, high-cost admissions to nonprofit hospitals. The 2 medical school hospitals that became for-profit experienced decreases in volume and resource intensity, coupled at one with an increase in severity. However, these patterns were produced more by the system's financial instability than by consolidation or conversion.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.