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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Health Services Research 1/2018

Association of hospice utilization and publicly reported outcomes following hospitalization for pneumonia or heart failure: a retrospective cohort study

Zeitschrift:
BMC Health Services Research > Ausgabe 1/2018
Autoren:
Soowhan Lah, Emily L. Wilson, Sarah Beesley, Iftach Sagy, James Orme, Victor Novack, Samuel M. Brown
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12913-017-2801-3) contains supplementary material, which is available to authorized users.

Abstract

Background

The Center for Medicare and Medicaid Services (CMS) and the Hospital Quality Alliance began collecting and reporting United States hospital performance in the treatment of pneumonia and heart failure in 2008. Whether the utilization of hospice might affect CMS-reported mortality and readmission rates is not known.

Methods

Hospice utilization (mean days on hospice per decedent) for 2012 from the Dartmouth Atlas (a project of the Dartmouth Institute that reports a variety of public health and policy-related statistics) was merged with hospital-level 30-day mortality and readmission rates for pneumonia and heart failure from CMS. The association between hospice use and outcomes was analyzed with multivariate quantile regression controlling for quality of care metrics, acute care bed availability, regional variability and other measures.

Results

2196 hospitals reported data to both CMS and the Dartmouth Atlas in 2012. Higher rates of hospice utilization were associated with lower rates of 30-day mortality and readmission for pneumonia but not for heart failure. Higher quality of care was associated with lower rates of mortality for both pneumonia and heart failure. Greater acute care bed availability was associated with increased readmission rates for both conditions (p < 0.05 for all).

Conclusions

Higher rates of hospice utilization were associated with lower rates of 30-day mortality and readmission for pneumonia as reported by CMS. While causality is not established, it is possible that hospice referrals might directly affect CMS outcome metrics. Further clarification of the relationship between hospice referral patterns and publicly reported CMS outcomes appears warranted.
Zusatzmaterial
Additional file 1: Online Data Supplement. Table S1. Chronic conditions in the dartmouth atlas chronic illness cohort. Table S2. Inpatient quality indicators collected by the center for medicare and medicaid services, 2012. Table S3. Hospital characteristics by quantile of hospice utilization. Table S4. Quantile regression of heart failure 30-day mortality rates. Table S5. Quantile regression of heart failure 30-day readmission rates. Table S6. Pneumonia mortality quantile regression detailed results. Table S7. Pneumonia readmission quantile regression detailed results. Table S8. Heart failure mortality quantile regression detailed results. Table S9. Heart failure readmission quantile regression detailed results. Table S10. Pneumonia mortality multi-level model. Table S11. Pneumonia readmission multi-level model. Table S12. Heart failure mortality multi-level model. Table S13. Heart failure readmission multi-level model. (DOCX 42 kb)
12913_2017_2801_MOESM1_ESM.docx
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