Association of Health Professional Shortage Area Hospital Designation With Surgical Outcomes and Expenditures Among Medicare Beneficiaries.

Autor:	Mullens CL; Department of Surgery, University of Michigan, Ann Arbor, MI.; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI., Lussiez A; Department of Surgery, University of Michigan, Ann Arbor, MI.; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI., Scott JW; Department of Surgery, University of Michigan, Ann Arbor, MI.; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI., Kunnath N; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI., Dimick JB; Department of Surgery, University of Michigan, Ann Arbor, MI.; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI., Ibrahim AM; Department of Surgery, University of Michigan, Ann Arbor, MI.; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI.; Taubman College of Architecture and Urban Planning, University of Michigan, Ann Arbor, MI.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2023 Oct 01; Vol. 278 (4), pp. e733-e739. Date of Electronic Publication: 2022 Nov 24.
DOI:	10.1097/SLA.0000000000005762
Abstrakt:	Objective: To compare surgical outcomes and expenditures at hospitals located in Health Professional Shortage Areas to nonshortage area designated hospitals among Medicare beneficiaries. Background: More than a quarter of Americans live in federally designated Health Professional Shortage Areas. Although there is growing concern that medical outcomes may be worse, far less is known about hospitals providing surgical care in these areas. Methods: Cross-sectional retrospective study from 2014 to 2018 of 842,787 Medicare beneficiary patient admissions to hospitals with and without Health Professional Shortage Area designations for common operations including appendectomy, cholecystectomy, colectomy, and hernia repair. We assessed risk-adjusted outcomes using multivariable logistic regression accounting for patient factors, admission type, and year were compared for each of the 4 operations. Hospital expenditures were price-standardized, risk-adjusted 30-day surgical episode payments. Primary outcome measures included 30-day mortality, hospital readmissions, and 30-day surgical episode payments. Results: Patients (mean age=75.6 years, males=44.4%) undergoing common surgical procedures in shortage area hospitals were less likely to be White (84.6% vs 88.4%, P <0.001) and less likely to have≥2 Elixhauser comorbidities (75.5% vs 78.2%, P <0.001). Patients undergoing surgery at Health Professional Shortage Area hospitals had lower risk-adjusted rates of 30-day mortality (6.05% vs 6.69%, odds ratio=0.90, CI, 0.90-0.91, P <0.001) and readmission (14.99% vs 15.74%, odds ratio=0.94, CI, 0.94-0.95, P <0.001). Medicare expenditures at Health Professional Shortage Area hospitals were also lower than nonshortage designated hospitals ($28,517 vs $29,685, difference= -$1168, P <0.001). Conclusions: Patients presenting to Health Professional Shortage Area hospitals obtain safe care for common surgical procedures without evidence of higher expenditures among Medicare beneficiaries. These findings should be taken into account as current legislative proposals to increase funding for care in these underserved communities are considered. Competing Interests: J.B.D. is a cofounder of ArborMetrix, Inc., a company that makes software for profiling hospital quality and efficiency. A.M.I. is a Principal at HOK architects, a global design and architecture firm. The remaining authors report no conflicts of interest. (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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