National Healthcare Quality and Disparities Report
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 1 of 1 Research Studies DisplayedDiaz A, Lindau ST, Obeng-Gyasi S
Association of hospital quality and neighborhood deprivation with mortality after inpatient surgery among Medicare beneficiaries.
The purpose of this cross-sectional study was to compare postoperative mortality among Medicare beneficiaries based on the level of neighborhood deprivation where they live and the hospital quality where they received care. The researchers examined outcomes among Medicare beneficiaries undergoing one of five common surgical procedures (colon resection, coronary artery bypass, cholecystectomy, appendectomy, or incisional hernia repair) between 2014 and 2018. Hospital quality was assigned using the Centers for Medicare & Medicaid Services Star Rating. Each beneficiary's neighborhood was identified at the census tract level and sorted into quintiles based on its Area Deprivation Index score. A risk matrix across hospital quality and neighborhood deprivation was created to determine the relative contribution of each to mortality after surgery. Data were analyzed from June 1 to December 31, 2021. The study included 1,898,829 Medicare beneficiaries. Patients from all neighborhood deprivation group quintiles sought care at hospitals across hospital quality levels. Thirty-day risk-adjusted mortality varied across high- and low-quality hospitals and across the least and most deprived neighborhoods. When combined, comparing patients from the least deprived neighborhoods going to high-quality hospitals vs patients from the most deprived neighborhoods going to low-quality hospitals, the variation increased further. The researchers concluded that both a patient's neighborhood and the hospital where they received treatment were associated with the risk of death after commonly performed inpatient surgical procedures. The associations of these factors on mortality may be additive. Efforts to address variation in postoperative mortality should include both hospital quality improvement and addressing drivers of neighborhood deprivation.
AHRQ-funded; HS028606.
Citation: Diaz A, Lindau ST, Obeng-Gyasi S .
Association of hospital quality and neighborhood deprivation with mortality after inpatient surgery among Medicare beneficiaries.
JAMA Netw Open 2023 Jan; 6(1):e2253620. doi: 10.1001/jamanetworkopen.2022.53620..
Keywords: Hospitals, Quality of Care, Surgery, Mortality, Social Determinants of Health