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19-07-2012 | Article

'Safety-net' hospitals have holes in quality


Free abstract

MedWire News: So-called "safety-net hospitals" (SNHs) provide second-class care, results of a study suggest.

SNHs, defined as US hospitals with a disproportionately high share of elderly patients on Supplemental Security Income and Medicaid, scored lower than non-SNH hospitals on nearly all patient-experience performance measures, report Ashish Jha (Harvard School of Public Health, Boston, Massachusetts, USA) and colleagues.

Patients in SNHs were significantly less likely to give good overall scores on a 10-point global measure of patient experience than their peers in other hospitals (63.9 vs 69.5%). In addition, SNH patients were significantly less likely to have received discharge information and to report that they always communicated well with their physicians than those in other hospitals.

The findings are important because the Centers for Medicare and Medicaid Services' value-based purchasing (VBP) program penalizes poor quality hospitals, the investigators note in the Archives of Internal Medicine.

"Given that hospital payments are now tied to performance on these measures, we need renewed efforts to track performance of SNHs under VBP and may need specific quality-improvement programs targeting these organizations," Jha et al write.

"SNHs play a critical role in providing medical care to vulnerable populations, and ensuring that efforts to improve the quality of care at US hospitals do not worsen, existing disparities will be a key challenge to policy makers."

To arrive at their conclusions, the authors looked at data on patient experience from the Hospital Consumer Assessment of Health Providers and Systems survey for 3096 US hospitals in 2007 and 2010.

Compared with hospitals in the lowest three quartiles of the Disproportionate Share Hospital Index, SNHs scored significantly worse on adequate nursing services, pain management, and quietness of the hospital environment.

The researchers note that although previous studies have shown that SNHs score lower than other hospitals on process-of-care measures, their study appears to be the first looking at the problem from the patient's perspective.

By Neil Osterweil