BACKGROUND CONTEXT
The incidence of adverse care quality events among patients undergoing cervical fusion surgery is unknown using the definition of care quality employed by the Centers for Medicare and Medicaid Services (CMS). The effect of insurance status on the incidence of these adverse quality events is also unknown.
PURPOSE
This study determined the incidence of hospital acquired conditions (HAC) and patient safety indicators (PSI) in cervical spine fusion patients and analyzed the association between primary payer status and these adverse events.
STUDY DESIGN
Retrospective cohort design
PATIENT SAMPLE
All patients in the Nationwide Inpatient Sample (NIS) aged eighteen and older that underwent cervical spine fusion from 1998β2011 were included.
OUTCOME MEASURES
Incidence of HAC and PSI from 1998β2011.
METHODS
We queried the NIS for all hospitalizations that included a cervical fusion during the inpatient episode from 1998β2011. All comparisons were made between privately insured patients and Medicaid/self-pay patients because Medicare enrollment is confounded with age. Incidence of non-traumatic HAC and PSI were determined using publicly available lists of ICD-9-CM diagnosis codes. We built logistic regression models to determine the effect of primary payer status on PSI and non-traumatic HAC.
RESULTS
We identified 419,424 hospitalizations with cervical fusion performed during an inpatient episode. The estimated national incidences of non-traumatic HAC and PSI were 0.35% and 1.6%, respectively. After adjusting for patient demographics and hospital characteristics, Medicaid/self-pay patients had significantly greater odds of experiencing one or more HAC (OR 1.51 95% CI 1.23β1.84) or PSI (OR 1.52 95% CI 1.37β1.70) relative to the privately-insured cohort.
CONCLUSION
Among patients undergoing inpatient cervical fusion, primary payer status predicts PSI and HAC (both indicators of adverse healthcare quality used to determine hospital reimbursement by CMS). As the U.S. healthcare system transitions to a value-based payment model, the cause of these disparities must be studied to improve the quality of care delivered to vulnerable patient populations.