Shifts in Medicaid and Uninsured Payer Mix at Safety-Net and Non-Safety-Net Hospitals During the Great Recession.

There has been ongoing concern regarding the viability of safety-net hospitals (SNHs), which care for vulnerable populations. The authors examined payer mix at SNHs and non-SNHs during a period covering the Great Recession using data from the 2006 to 2012 Healthcare Cost and Utilization Project State Inpatient Databases from 38 states. The number of privately insured stays decreased at both SNHs and non-SNHs.

Managed care and inpatient mortality in adults: effect of primary payer.

Background: Because managed care is increasingly prevalent in health care finance and delivery, it is important to ascertain its effects on health care quality relative to that of fee-for-service plans. Some stakeholders are concerned that basing gatekeeping, provider selection, and utilization management on cost may lower quality of care. To date, research on this topic has been inconclusive, largely because of variation in research methods and covariates.

Differences in severity at admission for heart failure between rural and urban patients: the value of adding laboratory results to administrative data.

Background: Rural/urban variations in admissions for heart failure may be influenced by severity at hospital presentation and local practice patterns. Laboratory data reflect clinical severity and guide hospital admission decisions and treatment for heart failure, a costly chronic illness and a leading cause of hospitalization among the elderly. Our main objective was to examine the role of laboratory test results in measuring disease severity at the time of admission for inpatients who reside in rural and urban areas.

Understanding Racial and Ethnic Disparities in Postsurgical Complications Occurring in U.S. Hospitals.

Objective: To examine the role of patient, hospital, and community characteristics on racial and ethnic disparities in in-hospital postsurgical complications.

Data Sources: Healthcare Cost and Utilization Project, 2011 State Inpatient Databases; American Hospital Association Annual Survey of Hospitals; Area Health Resources Files; Centers for Medicare & Medicaid Services Hospital Compare database.

Methods: Nonlinear hierarchical modeling was conducted to examine the odds of patients experiencing any in-hospital postsurgical complication, as defined by Agency for Healthcare Research and Quality Patient Safety Indicators.

Statewide Hospital Discharge Data: Collection, Use, Limitations, and Improvements.

Objectives: To provide an overview of statewide hospital discharge databases (HDD), including their uses in health services research and limitations, and to describe Agency for Healthcare Research and Quality (AHRQ) Enhanced State Data grants to address clinical and race-ethnicity data limitations.

Principal Findings: Almost all states have statewide HDD collected by public or private data organizations. Statewide HDD, based on the hospital claim with state variations, contain useful core variables and require minimal collection burden.

Racial differences in hospital mortality for medical and surgical admissions: variations by patient and hospital characteristics.

Objective: To determine if there are disparities between White and Black inpatient mortality rates for specific medical and surgical conditions and whether disparities vary by patient and hospital subgroups.

Design, Setting, Participants: All-payer discharge records in the 2009 Healthcare Cost and Utilization Project, State Inpatient Databases (SID) for 36 states that comprised about 80% of the Black and White populations in the United States were used to create a random, stratified sample of about 1,900 community hospitals (a 40% sample of US hospitals). All discharges in the hospitals were included and weighted for national estimates.

Disparities in rates of inpatient mortality and adverse events: race/ethnicity and language as independent contributors.

Patients with limited English proficiency have known limitations accessing health care, but differences in hospital outcomes once access is obtained are unknown. We investigate inpatient mortality rates and obstetric trauma for self-reported speakers of English, Spanish, and languages of Asia and the Pacific Islands (API) and compare quality of care by language with patterns by race/ethnicity. Data were from the United States Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, 2009 State Inpatient Databases for California.

Health information technology and hospital patient safety: a conceptual model to guide research.

Background: The literature indicates that health information technology (IT) use may lead to some gains in the quality and safety of care in some situations but provides little insight into this variability in the results that has been found. The inconsistent findings point to the need for a conceptual model that will guide research in sorting out the complex relationships between health IT and the quality and safety of care.

Methods: A conceptual model was developed that describes how specific health IT functions could affect different types of inpatient safety errors and that include contextual factors that influence successful health IT implementation.

Despite overall improvement in surgical outcomes since 2000, income-related disparities persist.

Despite improvements in health care, disparities in care still exist and are widening for some health measures. This study examined postsurgical outcomes for patients from low-income areas as compared to outcomes for those from high-income areas in the United States from 2000 to 2009. We found that postsurgical outcomes improved in general, with significant decreases in nine of twelve mortality and patient safety measures and an increase in one measure.

Ethnic differences in potentially preventable hospitalizations among Asian Americans, Native Hawaiians, and other Pacific Islanders: implications for reducing health care disparities.

Objectives: A serious challenge to eliminating US health disparities stems from the inability to reliably measure outcomes, particularly for numerically small populations. Our study aimed to produce reliable estimates of health care quality among Native Hawaiian (NH), Other Pacific Islander (PI), and Asian American (AA) subgroups.

Design: Prevention Quality Indicators (PQIs) from the Agency for Healthcare Research and Quality were used to calculate 3 PQI composites and 8 individual chronic condition indicators.

Congestive heart failure: who is likely to be readmitted?

Readmission for congestive heart failure (CHF) is the most common reason for readmission among Medicare fee-for-service patients. Yet CHF readmissions are not just a Medicare problem. This study examined who is likely to be readmitted for CHF, using all-payer hospital discharges from 14 of the states participating in the Healthcare Cost and Utilization Project.

Annual report on health care for children and youth in the United States: focus on trends in hospital use and quality.

Objective: The aim of this study was to describe selected trends in hospital inpatient care for children between 2000 and 2007.

Study Design: Analysis was conducted of administrative data from annual nationwide databases of hospital discharges from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project, along with survey data from a nationally representative random sample of children from the Medical Expenditure Panel Survey. Hospital utilization rates and expenses, risk-adjusted rates of potentially avoidable hospitalization, and safety indicators in the hospital are calculated and tracked with established and downloadable software.