Demographics matter: the potentially disproportionate effect of COVID-19 on hospital ratings

Abstract

Background We analyze a sample of 2,816 Medicare-certified acute care hospitals across all US states, using January to December 2019 CMS Hospital Compare datasets merged with county-level socio-demographic data. These data allow us to identify how features of the community in which a hospital serves differentially relate to its patients’ experiences based on the quality of that hospital. Methods A Finite Mixture Model (FMM) is used to uncover a mix of latent groups of hospitals that differ in quality. In the FMM, a multinomial logistic equation relates hospital-level factors to the odds of being in a particular group. And a multiple linear regression relates the characteristics of communities served by hospitals to the patients’ expected ratings of their experiences at hospitals in each group. Thus, this association potentially varies with hospital quality. We conducted the analysis via Stata. Results We provide evidence that relatively low-quality hospitals have much more variability in patient experience ratings than relatively high-quality ones. Moreover, the experiences at low-quality hospitals are more sensitive to county demographic factors, which means exogenous shocks, like COVID-19, will likely affect these hospitals differently, as such shocks are known to disproportionately affect their communities. Conclusion Our results imply that low-quality hospitals with more variability in their HCAHPS responses are more likely to face adverse patient experiences due to COVID-19 than relatively high-quality hospitals. Pandemics like COVID-19 create conditions that intensify the already high demands placed on hospitals and make it even more challenging to deliver quality care.

The physician CEO advantage and hospital performance during the COVID-19 pandemic: capacity utilization and patient satisfaction

“…Further, we also believe that focusing on top-rated hospitals can be useful if factors associated with performance can be identified and lessons learned can be used by other hospitals. For example, a recent study showed that low-rated hospitals are more likely to face adverse patient experiences due to COVID-19 than high-rated hospitals (Belasen et al, 2021b). An important pathway is to encourage collaboration across the continuum of care and the sharing of information between healthcare systems.…”

“…They are important since they directly impact hospitals’ reputation as well as the financial incentives hospitals receive from CMS (Belasen et al. , 2021a, b, c). Furthermore, the association between capacity utilization and patient satisfaction is well established in the literature (Biondi et al.…”

“…Ensuring access to quality of care is rooted in a social justice and public health imperatives. Unfortunately, the COVID-19 pandemic has disproportionally affected the poor, minorities and a broad range of vulnerable populations (Belasen et al, 2021b). It is far from a pareto optimal scenario and one that represents an on-going public health challenge that should be further examined and researched.…”

“…Ensuring access to quality of care is rooted in a social justice and public health imperatives. Unfortunately, the COVID-19 pandemic has disproportionally affected the poor, minorities and a broad range of vulnerable populations (Belasen et al. , 2021b).…”

Adult Experiences with Hospitalization in Alberta, Canada During the COVID-19 Pandemic: A Comparative Cross-Sectional Study

“…This study has limitations that warrant consideration. Although we controlled for a variety of demographic and clinical factors, it is possible that our data set did not contain any other explanatory factors (23)(24)(25)(26). Given the nature of surveys, which ask respondents to reflect on past events, the potential for recall bias cannot be discounted (27).…”