Differences in the rates of patient safety events by payer: implications for providers and policymakers.

BACKGROUND: The reduction of adverse patient safety events and the equitable treatment of patients in hospitals are clinical and policy priorities. Health services researchers have identified disparities in the quality of care provided to patients, both by demographic characteristics and insurance status. However, less is known about the extent to which disparities reflect differences in the places where patients obtain care, versus disparities in the quality of care provided to different groups of patients in the same hospital. OBJECTIVE: In this study, we examine whether the rate of adverse patient safety events differs by the insurance status of patients within the same hospital. METHODS: Using discharge data from hospitals in 11 states, we compared risk-adjusted rates for 13 AHRQ Patient Safety Indicators by Medicare, Medicaid, and Private payer insurance status, within the same hospitals. We used multivariate regression to assess the relationship between insurance status and rates of adverse patient safety events within hospitals. RESULTS: Medicare and Medicaid patients experienced significantly more adverse safety events than private pay patients for 12 and 7 Patient Safety Indicators, respectively (at P < 0.05 or better). However, Medicaid patients had significantly lower event rates than private payers on 2 Patient Safety Indicators. CONCLUSIONS: Risk-adjusted Patient Safety Indicator rates varied with patients' insurance within the same hospital. More research is needed to determine the cause of differences in care quality received by patients at the same hospital, especially if quality measures are to be used for payment.

The quality of care delivered to patients within the same hospital varies by insurance type.

In attempting to explain why hospitals vary in the quality of care delivered to patients, a considerable body of health policy research points to differences in hospital characteristics such as ownership, safety-net status, and geographic location as the most important contributing factors. This article examines the extent to which a patient's type or lack of insurance may also play a role in determining the quality of care received at any given hospital. We compared within-hospital quality, as measured by risk-adjusted mortality rates, for patients according to their insurance status. We examined the Agency for Healthcare Research and Quality's innovative Inpatient Quality Indicators and pooled 2006-08 State Inpatient Database records from eleven states. We found that privately insured patients had lower risk-adjusted mortality rates than did Medicare enrollees for twelve out of fifteen quality measures examined. To a lesser extent, privately insured patients also had lower risk-adjusted mortality rates than those in other payer groups. Medicare patients appeared particularly vulnerable to receiving inferior care. These findings suggest that to help reduce care disparities, public payers and hospitals should measure care quality for different insurance groups and monitor differences in treatment practices within hospitals.

Do minority patients use lower quality hospitals?

Employing three years of inpatient discharge data from 11 states and inpatient and patient safety quality indicators from the Agency for Healthcare Research and Quality (AHRQ), this paper explored whether minority (black, Hispanic, and Asian) patients used lower quality hospitals. We found that the association between the share of minority patients and hospital quality depended on how quality was measured and varied by race and ethnicity. Hospitals serving Hispanics performed well on most patient safety measures. Higher percentages of all three minority patient groups corresponded to lower quality for only one measure, postoperative sepsis. Our analysis indicates that it is incorrect to generalize that minorities use lower quality hospitals. Analysts and policymakers should be cautious when making generalizations about the overall service quality of hospitals that treat minority patients.

Patterns and predictors of restrictive health care service use by youths with bipolar disorder.

Patterns of behavioral health service utilization were examined among youth diagnosed with bipolar disorder (n = 832). Youth were categorized as high, moderate, and low restrictive service users (43, 7, and 50%, respectively). Factors associated with receiving care in highly restrictive settings included: numerous co-occurring diagnoses and being enrolled in managed care. Youth with regular outpatient visits were less likely to receive care in highly restrictive settings. This analysis provides a broad and dramatic picture of the intensity of services needed by most youth with bipolar. Having regular outpatient services shows promise with regard to reducing costly care in restrictive settings.

Do hospitals provide lower-quality care to minorities than to whites?

Using three years of state inpatient discharge data from thirteen states, we computed, for each hospital, race/ethnicity-specific quality measures using the Agency for Healthcare Research and Quality inpatient quality indicators and patient safety indicators. We found that risk-adjusted quality indicators for blacks, Hispanics, and Asians were not statistically worse than corresponding quality indicators for whites in the same hospital. We conclude that when whites and minorities are admitted to the hospital for the same reason or receive the same hospital procedure, they receive the same quality of care. Only a few hospitals provide lower quality of care to minorities than to whites.