Hospital Characteristics and Mortality Rates

TLDR

The Health Care Financing Administration annually publishes hospital mortality rates. The study aimed to identify hospital characteristics linked to variations in those mortality rates. Researchers analyzed data from 3,100 hospitals in the 1986 HCFA mortality study and the American Hospital Association survey, adjusting rates for case mix and patient characteristics and comparing quartiles of hospital attributes. Adjusted mortality was 116 per 1,000 admissions, higher in for‑profit (121), public (120), and osteopathic (129) hospitals, and lower in private teaching hospitals (108) versus non‑teaching (116); similar patterns emerged for board‑certified physicians, occupancy, payroll per bed, and registered nurses. N Engl J Med 1989; 321: 1720–5.

Abstract

Abstract The Health Care Financing Administration (HCFA) publishes hospital mortality rates each year. We undertook a study to identify characteristics of hospitals associated with variations in these rates. To do so, we obtained data on 3100 hospitals from the 1986 HCFA mortality study and the American Hospital Association's 1986 annual survey of hospitals. The mortality rates were adjusted for each hospital's case mix and other characteristics of its patients. The mortality rate for all hospitalizations was 116 per 1000 patients. Adjusted mortality rates were significantly higher for for-profit hospitals (121 per 1000) and public hospitals (120 per 1000) than for private not-for-profit hospitals (114 per 1000; P<0.0001 for both comparisons). Osteopathic hospitals also had an adjusted mortality rate that was significantly higher than average (129 per 1000; P<0.0001). Private teaching hospitals had a significantly lower adjusted mortality rate (108 per 1000) than private nonteaching hospitals (116 per 1000; P<0.0001). Adjusted mortality rates were also compared for hospitals in the upper and lower fourths of the sample in terms of certain hospital characteristics. The mortality rates were 112 and 121 per 1000 for the hospitals in the upper and lower fourths, respectively, in terms of the percentage of physicians who were board-certified specialists (P<0.0001), 112 and 120 per 1000 for occupancy rate (P<0.0001), 113 and 120 per 1000 for payroll expenses per hospital bed (P<0.0001), and 113 and 119 per 1000 for the percentage of nurses who were registered (P<0.0001). (N Engl J Med 1989; 321: 1720–5.)