Quality of care in hospitals with a high percent of Medicaid patients.
BACKGROUND
Certain hospitals play a central role in ensuring Medicaid-insured patients' access to care. Their quality of care is critical to evaluate.


OBJECTIVE
To determine whether hospitals for which Medicaid patients represent a high percentage of total discharges provide a different quality of care than other hospitals.


METHODS
Cross-sectional analysis.


METHODS
Acute care hospitals participating in the first Hospital Compare public report (released November 2004) and the 2004 American Hospital Association hospital survey.


METHODS
Hospitals serving 1 standard deviation above the national mean percentage of Medicaid patients were designated high Medicaid hospitals. Performance was assessed using percent compliance with 10 processes of care for 3 conditions: myocardial infarction, congestive heart failure, and community-acquired pneumonia.


RESULTS
Among the 2874 nonteaching hospitals, high Medicaid hospitals had lower adherence (P < 0.01) than other nonteaching hospitals on all 10 indicators. Of particular clinical importance, high Medicaid nonteaching hospitals less frequently prescribed beta-blockers (83% vs. 90%%, P < 0.0001) and aspirin at discharge in myocardial infarction (85% vs. 91%%, P < 0.0001), and administered antibiotics on time in CAP (68% vs. 75%, P < 0.0001). Among teaching institutions, there were few differences between high Medicaid and other hospitals.


CONCLUSIONS
Among hospitals publicly reporting on the Hospital Compare Web site, nonteaching hospitals treating a high percentage of Medicaid patients had lower adherence to quality indicators than other nonteaching hospitals on 10 indicators. Further research is needed to determine what factors contribute to differences in reported quality.
Goldman
L Elizabeth
LE
Departments of Medicine, University of California, San Francisco, San Francisco, California 94110, USA. goldmanl@medicine.ucsf.edu
Vittinghoff
Eric
E
Dudley
R Adams
RA
D003430:Cross-Sectional Studies; D019983:Guideline Adherence; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D016014:Linear Models; D008484:Medicaid / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D019984:Quality Indicators, Health Care; D012052:Reimbursement, Incentive; D014481:United States