Year: 2021
Type: article
Abstract: This cross-sectional ecological study used hospital-level, risk-adjusted performance measures and patient volume for the following 3 conditions or procedures available in the Centers for Medicare and Medicaid Services' Hospital Care Compare database: acute myocardial infarction (AMI), coronary artery bypass graft (CABG), and hip and/or knee replacement.They were selected to exemplify nonelective, semielective, and mostly elective conditions or procedures, respectively.Performance measures included 30-day mortality rate and 30-day readmission rate for AMI and CABG and 90-day complication rate for hip and/or knee replacement for the 2019 report year, reflecting performance in July 1, 2015, through June 30, 2018.Each hospital's condition-or procedure-specific volume was obtained from the 2020 report year, reflecting patient volumes in July 1, 2016, through June 30, 2019.4 The performance score period preceded the volume period by 1 year to account for how consumers have access only to past, as opposed to contemporary, quality measurements.Market share was calculated by dividing the hospital's volume by the sum of the volume of all hospitals in the hospital referral region (HRR).Hospital and HRR characteristics were derived from the Hospital Care Compare database, the Dartmouth Atlas, 5 the American Community Survey, and the US Decennial Census.6 This research did not meet the National Institutes of Health definition of human subject research as specified in 45 CFR part 46, and was therefore exempt from institutional review board approval.We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.Fractional regressions via generalized linear models with binomial family and logit links were used to model hospital market share for each condition or procedure while adjusting for hospital and HRR characteristics.All estimates reflected marginal effects along with their 95% CIs.Variables adjusted for included number of beds (in tercile), HRR concentration, hospital type (acute care vs critical access), hospital ownership, teaching status, region, HRR population size (in tercile), HRR percentage of the non-White population (in tercile), HRR percentage of the population in rural area (in tercile), HRR percentage of the population with less than a high school education (in tercile), and HRR percentage of the population below the federal poverty level (in tercile).The reference level for tercile variables was the first (lowest) tercile.Terciles were calculated by measure.Two-tailed P < .05 was considered statistically significant.Analysis was conducted using RStudio, version 1.2 (RStudio PBC).The eMethods in the Supplement describes additional methodologic considerations.
Source: JAMA Network Open
Institution: Yale University
Language: English
Subfield: Health Information Management
Field: Health Professions
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,000
OpenAlex ID: W3205447620