Mortality rates decreased among patients admitted for acute myocardial infarction (AMI), congestive heart failure (CHF), stroke and pneumonia from 2002 to 2012, according to the Agency for Healthcare Research and Quality (AHRQ). The decline occurred for both men and women, and for Medicare-aged and younger patients.
The Journal of the American Medical Association (JAMA) also reported a decline in inpatient mortality for Medicare patients from 1999 to 2013.
AHRQ findings included:
- Mortality decreased most among patients admitted for pneumonia (45 percent decrease). AMI, CHF and stroke decreased by 41, 29 and 27 percent respectively.
- Inpatient mortality decreases varied by condition and region: the largest decline was among pneumonia patients in hospitals in the Northeast (52 percent); the smallest was 22 percent among stroke patients in the West.
- Overall inpatient mortality for the four conditions decreased among patients in each major insurance category.
- Pneumonia: The largest decreases occurred among pneumonia patients covered by Medicare (46 percent) and Medicaid (56 percent) and also among uninsured patients (55 percent).
- AMI: decreases of 41 percent for Medicare and Medicaid patients.
- CHF: decrease of 40 percent for Medicaid patients. However, decreases for patients with private insurance or no insurance were not statistically significant.
- Stroke: decrease of 42 percent for uninsured patients.
Decreases Across Income Categories
The AHRQ research also found that:
- Inpatient mortality rates for the four conditions improved among all income levels. However, some of the largest improvements occurred among the poorest patients for some conditions.
- Inpatient mortality for pneumonia decreased by nearly half for all income levels, including a 43 percent drop among patients in the poorest communities and a 48 percent decrease in the wealthiest communities.
- Decreases in CHF and stroke mortality were largest for patients in the poorest communities (34 percent and 30 percent, respectively) and smallest for those in the wealthiest communities (24 percent and 23 percent, respectively).
Decreases Across Regions Reported by AHRQ
- Improvement in inpatient mortality seemed to spread among geographic areas, the largest being among pneumonia patients living in metropolitan areas (47 percent).
- For AMI, inpatient mortality decreased 41 percent for patients in metro areas, 40 percent in micropolitan areas and 42 percent in rural areas.
In addition to studies published by AHRQ and the Journal of the American Medical Association, the Medicare Payment Advisory Commission reported in March that from 2010 through 2013, hospitals had statistically significant improvements in seven of 10 mortality rate measures, comprising in-hospital and 30-day post-discharge mortality for five prevalent clinical conditions. (“Inpatient Mortality Declines Across Payers,” HFMA Weekly News, August 21, 2015)
Why the Recent Decline?
Some industry analysts credit the rolling implementation of hospital quality initiatives of the Affordable Care Act for improved hospital patient outcomes in recent years. Other experts “have warned those same programs could begin worsening outcomes for some categories of hospitals by draining resources that are needed to improve care.” (“Inpatient Mortality Declines Across Payers,” HFMA Weekly News, August 21, 2015)
Consumerism: Strategic and Financial Implications, Part Two is in your library now. In this course, Mark Grube (Kaufman Hall), Marian Jennings (M. Jennings Consulting) and Nathan Kaufman (Kaufman Strategic Advisors) discuss organizational characteristics for a retail strategy, the financial implications and “must-do’s” for hospitals and systems. And coming up in late September, part one of Integrating Population Health into Your Strategic and Financial Plans.
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