Quality care lacking in US territory hospitals vs. stateside hospitals

Nunez-Smith M. Arch Intern Med. 2011;doi:10.1001/archinternmed.2011.284.

Hospitals in US territories have higher mortality rates and low performance scores on process measures for patients discharged for acute myocardial infarction, heart failure and pneumonia compared with stateside hospitals. According to researchers, eliminating this disparity should be a national priority.

“Despite the national effort to address health care disparities through increased public reporting and standardizing hospital performance, hospitals in the US territories have been largely neglected,” the researchers wrote. “Improving health care outcomes in the US territories should be included in any comprehensive effort to tackle national racial/ethnic and other health care disparities.”

Researchers compared the performance of 57 US territory hospitals with that of 4,799 stateside hospitals using outcome (30-day risk rates for all-cause mortality and all-cause readmission) and core process (evidence-based standards of care) measures. The study included nonfederal hospitals discharging Medicare fee-for-service patients with a diagnosis of acute MI, HF or pneumonia between July 2005 and June 2008, according to the researchers.

US territory hospitals had a higher rate of 30-day risk-standard mortality compared with stateside hospitals (P<.001), which was true for acute MI (18.8% vs. 16%), HF (12.3% vs. 10.8%) and pneumonia (14.9% vs. 11.4%). Territorial hospitals also had higher hospital mean 30-day risk-standardized readmission rates in patient with acute MI (20.6% vs. 19.8%; P=.04) and pneumonia (19.4% vs. 18.4%; P=.01), but the rate was not significant among patients with HF (25.5% vs. 24.5%; P=.07).

After adjusting for hospital characteristics and core process measure performance, the rate of risk-standardized mortality remained high in US territory hospitals. The performance was lower in US territory hospitals for all core process measures (P<.05).

“The striking disparity revealed in this study demonstrates that people living in the US territories are at a notable disadvantage compared with those in the US states,” the researchers wrote. “Importantly, these US possessions are legally restricted from full participation in the shaping of relevant US health care policy. The nation has a great responsibility to guarantee that residents on these islands have access to care that is at least of the same quality as care in the US states.”

Disclosures: Study researchers Sharon-Lise T. Normand, PhD, and Harlan M. Krumholz, MD, report they developed risk-standardized mortality rates and risk-standardized readmission rates for acute MI, HF and pneumonia under contract with the Colorado Foundation for Medical Care. Dr. Krumholz reports he chairs a scientific advisory board for United Healthcare. The analyses on which this study is based were supported by the Agency for Healthcare Quality and Research, the United Health Fund and the Commonwealth Fund. Study researcher Marcella Nunez-Smith, MD, was supported by the Association of American Medical Colleges’ Nickens Faculty Fellowship at the time the project was developed. Dr. Krumholz was supported by grant U01 HL105270 (Center for Cardiovascular Outcomes Research at Yale University) from the National Heart, Lung, and Blood Institute.

Follow CardiologyToday.com on Twitter.