Hospital Improvements Have Led To Marked Decreased In Inpatient Mortality Over Ten Years

MedicalResearch.com Interview with:
Kevin Heslin, Ph.D.
, Staff Service Fellow, Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality

Medical Research: What is the background for this study?

Dr. Heslin: Previous trends in inpatient mortality suggest that rates have been decreasing for acute myocardial infarction (AMI), congestive heart failure (CHF), stroke, and pneumonia (Hines et al., 2010; Stepanova et al., 2013).  Continued study of these trends can help researchers and policymakers assess the impact of health care quality efforts.  Further, examining trends across patient and hospital subgroups may inform strategies for addressing disparities in health care quality by identifying groups that are leading and lagging in improvement.

Medical Research: What is the background for this study

Dr. Heslin: From 2002 to 2012, inpatient mortality decreased among patients admitted to U.S. hospitals for pneumonia (45 percent decrease, from 65.0 to 35.8 deaths per 1,000 admissions), AMI (41 percent decrease, from 94.0 to 55.9 deaths per 1,000 admissions), CHF (29 percent decrease, from 44.4 to 31.4 deaths per 1,000 admissions), and stroke (27 percent decrease, from 112.6 to 82.6 deaths per 1,000 admissions).  The inpatient mortality rate for all four conditions decreased among both younger and older patients, and among men and women.

Medical Research: What should clinicians and patients take away from your report?

Dr. Heslin: The reductions in inpatient mortality rates reported by this brief suggest that hospitals are improving care for these conditions. This explanation is supported by other work on the quality of inpatient care for AMI, CHF, and pneumonia. Specifically, Nuti and colleagues (2015) analyzed data on more than 4,000 hospitals over the 2006-2011 period and ranked hospitals by their performance on evidence-based process of care measures, with a quality score of 100 being equal to perfect performance.  Over this period, hospital performance on all measures improved.  There was a decreasing difference between the quality scores of hospitals ranked at the 90th percentile and those of hospitals ranked 10th percentile. The variation between hospitals at these percentiles decreased from a 9% to 2% absolute difference for AMI, a 25% to 8% difference for congestive heart failure, and a 20% to 7% difference for pneumonia in 2006 and 2011, respectively.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Heslin: Future research to better ascertain the reasons for these reductions in inpatient mortality could inform not only improvements in the clinical management of these conditions, but also the development and modification of relevant health policies.  Given the dramatic decline in the number of Americans without health insurance since 2013 (Cohen and Martinez, 2015), one of the most important areas for future research is to assess the impact of the insurance coverage expansions made possible by the Affordable Care Act on hospitalization rates and outcomes for these four conditions.

References

Cohen RA, Martinez ME. Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, January–March 2015.  Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 2010–2015.

Hines, A. (Thomson Reuters), Stranges, E. (Thomson Reuters), and Andrews, R.M. (AHRQ). Trends in Hospital Risk-Adjusted Mortality for Select Diagnoses by Patient Subgroups, 2000–2007. HCUP Statistical Brief #98. October 2010. Agency for Healthcare Research and Quality, Rockville, MD.http://www.hcup-us.ahrq.gov/reports/statbriefs/sb98.pdf

Nuti SV, Wang Y, Masoudi FA, et al. Improvements in the distribution of hospital performance for the care of patients with acute myocardial infarction, heart failure, and pneumonia, 2006-2011. Medical Care; 2015; 53(6): 485-491.

Stepanova M, Venkatesan C, Altaweel L, Mishra A, and Younossi ZM. Recent trends in inpatient mortality and resource utilization for patients with stroke in the United States: 2005-2009. J Stroke Cerebrovas Dis. 2013; 22(4): 491-9.

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Kevin Heslin, Ph.D. (2015). Hospital Improvements Have Led To Marked Decreased In Inpatient Mortality Over Ten Years