Background
Methods
Data
Outcomes and co-Variates
Outcome variables
Co-variates
Statistical analysis
Results
Baseline characteristics
Variable | Overall | Group 1 (0% reduction) | Group 2 (0.5% reduction) | Group 3 (1% reduction) | Group 4 (≥1.5% reduction) |
---|---|---|---|---|---|
N (% of total) | 5089 | 3580 (70.3%) | 811 (15.9%) | 289 (5.7%) | 409 (8.0%) |
Facility level characteristics | |||||
For-Profit (% For-Profit by Payment Group)a
| 4205 | 2991 | 672 | 235 | 307 |
82.6% | 83.6% | 82.9% | 81.3% | 75.1% | |
Chain (% Chain by Payment Group)a
| 3676 | 2611 | 588 | 217 | 260 |
79.0% | 79.9% | 79.0% | 81.6% | 68.8% | |
Chain 1 | 1321 | 968 | 220 | 60 | 73 |
26.0% | 27.1% | 27.1% | 20.8% | 17.9% | |
Chain 2 | 1291 | 917 | 196 | 80 | 98 |
25.4% | 25.6% | 24.2% | 27.7% | 24.0% | |
Independent | 998 19.6% | 682 19.1% | 168 20.7% | 50 17.3% | 98 24.0% |
Other Chain (Reference) | 1477 29.0% | 1011 28.3% | 227 15.4% | 99 6.7% | 140 9.5% |
Size (#stations)a
| 17.63 | 17.15 | 19.36 | 19.74 | 18.63 |
[17.4,17.9] | [16.9,17.4] | [18.8,19.9] | [18.8,20.7] | [17.8,19.5] | |
Low (0–13) | 1667 32.8% | 1265 35.3% | 203 25.0% | 65 22.5% | 134 32.8% |
Medium (14–20) | 1845 36.25% | 1289 36.0% | 304 37.5% | 117 40.5% | 135 33.0% |
High (21–80) | 1577 31.0% | 1026 28.7% | 304 37.5% | 107 37.0% | 140 34.2% |
Length of Operation | 14.65 | 13.74 | 16.82 | 17.35 | 16.43 |
years (95% CIs)a
| [14.4, 14.9] | [13.4,14.02 | [16.2,17.4] | [16.3,18.4] | [15.6,17.3] |
Neighborhood level characteristics (mean, 95% CIs) | |||||
Percent African Americana
| 18.2% | 17.0% | 20.9% | 22.5% | 20.6% |
[17.5,18.8] | [16.3,17.8] | [19.1, 22.6] | [19.4, 25.5] | [18.0, 23.1] | |
Percent Poverty | 18.5% | 15.8% | 16.7% | 17.1% | 17.5% |
[18.1,18.8] | [15.8,16.1] | [16.1,17.3] | [16.0,18.2] | [16.5,18.5] | |
Outcomes (mean, 95% CIs) | |||||
Mean Total Performance Score* | 26.3 [26.1, 26.4] | 18.0 [17.6, 18.4] | 19.3 [18.4, 20.2] | 20.1 [18.5, 21.7] | 19.2 [17.9, 20.6] |
Bi-variable and multi-variable association between any payment reduction and facility and neighborhood covariates
Outcome: Any Payment Reduction vs. None | Bivariate | Multi-variate |
---|---|---|
Co-Variates | OR (95% CI) | OR (95% CI) |
Facility level characteristics | ||
Chain Type | ||
Other Chain | Referent | Referent |
Chain 1 | 0.78a [0.66, 0.92] | 0.77a [0.65, 0.91] |
Chain 2 | 0.84a [0.71, 1.00] | 0.74a [0.62, 0.88] |
Independent | 1.01 [0.85, 1.21] | 0.94 [0.78, 1.13] |
Total # Stations (per station) | ||
Low (0–13) | Referent | Referent |
Medium (14–20) | 1.41a [1.21, 1.65] | 1.30a [1.11, 1.53] |
High (21–80) | 1.81a [1.54, 2.12] | 1.42a [1.20, 1.69] |
Length of Operation (per year) | 1.04a [1.03, 1.04] | 1.03a [1.03, 1.04] |
Neighborhood Level Characteristics | ||
Percent African-American | ||
Quartile 1 ≤ 8.6% | Referent | Referent |
Quartile 2 8.6%–15.7% | 1.07 [0.90, 1.28] | 1.01 [0.84, 1.21] |
Quartile 3 15.7% -25% | 1.29a [1.08, 1.55] | 1.15 [0.96, 1.39] |
Quartile 4 > 25% | 1.52a [1.26, 1.83] | 1.25a [1.02, 1.54] |
Percent Below Federal Poverty Level | ||
Quartile 1 ≤ 1.7% | Referent | Referent |
Quartile 2 1.7% - 7.2% | 1.16 [0.98, 1.39] | 1.08 [0.90, 1.29] |
Quartile 3 7.2% - 24.9% | 1.18a [0.99, 1.41] | 1.06 [0.88, 1.28] |
Quartile 4 > 24.7% | 1.42a [1.19, 1.70] | 1.15 [0.95, 1.39] |
Bi-variable and multi-variable association between greatest payment reduction and facility and neighborhood
Change in clinical outcomes between 2007 and 2010 and facility and neighborhood covariates
Variable | Mean Change in Hgb <10 g/dL [95% CI]b
| Mean Change in Hgb > 12 g/dL [95% CI]b
| Change in URR < 65 [95% CI]c
|
---|---|---|---|
N (%) | 4259 | 4259 | 4191 |
All facilities | 1.36 [1.25, 1.47] | −33.87 [−34.52, −33.22] | −0.80 [−0.97, −0.62] |
Facility Level Characteristics | |||
Chain | |||
Others | 1.57 [1.36, 1.78] | −30.94 [−32.25, −29.64] | −0.97 [−1.36, −0.57] |
Chain 1 | 1.18 [1.00, 1.36] | −43.63a [−44.75,-42.53] | −0.25a [−0.54, 0.04] |
Chain 2 | 1.25 [1.05, 1.45] | −32.32a [−33.37,-32.27] | −0.96 [−1.24, −0.68] |
Independent | 1.42 [1.11, 1.73] | −27.39a [−28.94,-25.84] | −1.03 [−1.51, −0.55] |
Neighborhood Level Characteristics (mean, 95% CIs) | |||
Percent African-American | |||
Quartile 1 ≤ 8.6% | 1.27 [1.03, 1.50] | −30.85 [−32.21, −29.49] | −0.32 [0.67, 0.04] |
Quartile 2 8.6%–15.7% | 1.32 [1.11, 1.53] | −33.01 [−34.26, −31.76] | −0.96 [−1.42, −0.51] |
Quartile 3 15.7% -25% | 1.47 [1.26, 1.69] | −34.97a [−36.26,-33.68] | −0.80 [−1.12, −0.48] |
Quartile 4 > 25% | 1.36 [1.14, 1.58] | −36.48a [−37.73,-35.22] | −1.06a [−1.35, −0.76] |
Percent Below Federal Poverty Level | |||
Quartile 1 ≤ 1.7% | 1.31 [1.09, 1.53] | −33.19 [−34.50, −31.89] | −0.86 [−1.16, −0.55] |
Quartile 2 1.7% - 7.2% | 1.38 [1.16, 1.60] | −33.81 [−35.11, −32.52] | −0.79 [−1.16, −0.42] |
Quartile 3 7.2% - 24.9% | 1.30 [1.09, 1.50] | −34.52 [−35.83, −33.20] | −0.76 [−1.16, −0.37] |
Quartile 4 > 24.7% | 1.42 [1.18, 1.66] | −34.05 [−35.31, −32.79] | −0.76 [−1.12, −0.41] |
Payment Reduction | |||
1 0% | −0.16 [−0.26, −0.06] | −34.50 [−35.38, −33.82] | −1.58 [−1.78, −1.37] |
2 0.5% | 2.27a [2.09, 2.45] | −32.28 [−33.91, −30.65] | 0.39a [−0.04, 0.81] |
3 1% | 4.16a [3.98, 4.35] | −33.13 [−35.80, −30.46] | 1.11a [0.51, 1.72] |
4 ≥ 1.5% | 7.78a [7.44, 8.11] | −32.63 [−34.64, −30.62] | 0.69a [−0.04, 1.42] |
Co-Variates | Change in Hgb <10 g/dL [95% CI]b
| Change in Hgb > 12 g/dL [95% CI]b
| Change in URR < 65 [95% CI]c
|
---|---|---|---|
Coefficients | Coefficients | Coefficients | |
Facility Level Characteristics | |||
Chain Type | |||
Other chain | Referent | Referent | Referent |
Chain 1 | −0.38a [−0.68, −0.67] | −12.69a [−14.41, −10.98] | 0.91a [0.42, 1.41] |
Chain 2 | −0.41a [−0.72, −0.10] | −0.46 [−2.19, 1.26] | 0.14 [−0.35, 0.64] |
Independent | −0.08 [−0.41, 0.26] | 3.72a [1.84, 5.59] | −0.06 [−0.60, 0.49] |
Total # Stations (per station) | |||
Low (0–13) | Referent | Referent | Referent |
Medium (14–20) | −0.11 [−0.39, 0.17] | 0.12 [−0.47, 1.70] | −0.33 [−0.79, 0.14] |
High (21–80) | 0.11 [−0.20, 0.42] | 0.77 [−0.96, 2.49] | −0.37 [−0.87, 0.13] |
Length of Operation (per year) | 0.02a [0.00, 0.03] | 0.03 [−0.04, 0.11] | −0.003 [−0.03, 0.02] |
Neighborhood Level Characteristics | |||
Percent African-American | |||
Quartile 1 ≤ 8.6% | Referent | Referent | Referent |
Quartile 2 8.6%–15.7% | 0.07 [−0.25, 0.39] | −1.22 [−3.00, 0.57] | −0.63a [−1.15, −0.11] |
Quartile 3 15.7% −25% | 0.19 [−0.12, 0.55] | -2.42a [−4.29, −0.54] | −0.53a [−1.07, 0.01] |
Quartile 4 > 24.7% | 0.04 [−0.29, 0.45] | −3.43a [−5.52, −1.34] | −0.85a [−1.05, −0.27] |
Percent Below Federal Poverty Level | |||
Quartile 1 ≤ 1.7% | Referent | Referent | Referent |
Quartile 2 1.7% - 7.2% | 0.06 [−0.25, 0.38] | −0.33 [−2.08, 1.43] | 0.09 [−0.42, 0.60] |
Quartile 3 7.2% - 24.9% | 0.04 [−0.28, 0.37] | −0.53 [−2.35, 1.29] | 0.19 [−0.34, 0.71] |
Quartile 4 > 24.7% | 0.13 [−0.21, 0.47] | 0.80 [−1.10, 2.71] | 0.30 [−0.25, 0.85] |