Research Activities April 2013, No. 392
Quality of care is similar for safety-net and non-safety-net hospitals
Patient Safety and Quality
Safety-net hospitals are institutions typically located in urban areas that serve the poor and uninsured. These hospitals tend to struggle financially compared to their non-safety-net counterparts located in more affluent areas. Yet findings from a new study suggest that, despite their financial struggles, safety-net hospitals can achieve equal or even better outcomes compared to non-safety-net hospitals. It found similar hospital outcomes for mortality and readmission rates among Medicare patients hospitalized for three conditions at safety-net and non-safety-net hospitals. The margin of performance, on average, was less than one percentage point between safety-net and non-safety-net hospitals.
Yale and Harvard researchers looked at outcomes of fee-for-service Medicare patients age 65 and older who were hospitalized for heart attack, heart failure, or pneumonia. Patients were included from metropolitan areas that had at least one safety-net and one non-safety-net hospital. Patient deaths and hospital readmission from any cause within 30 days were analyzed from the data. Safety-net hospitals tended to be teaching institutions with higher average patient volumes for each condition compared to non-safety-net institutions. Mortality rates were just slightly higher at safety-net hospitals for heart attack and pneumonia. In the case of heart failure, mortality rates did not differ between safety-net and non-safety net hospitals. Similarly, readmission rates were just slightly higher at safety-net hospitals for heart attack and pneumonia. In the case of heart failure, readmission rates were modestly higher at safety-net hospitals. Importantly, for mortality and readmission rates, differences between the two types of hospitals within metropolitan statistical area ranged from no difference to 0.7 percentage points. The study was supported in part by AHRQ (HS18781).
See "Based on key measures, care quality for Medicare enrollees at safety-net and non-safety-net hospitals was almost equal," by Joseph S. Ross, M.D., Susannah M. Bernheim, M.D., M.H.S., Zhenqiu Lin, Ph.D., and others in the August 2012 Health Affairs 31(8), pp. 1739-1748.