title: Based on key measures, care quality for Medicare enrollees at safety-net and non-safety-net hospitals was almost equal.
abstract: Safety-net hospitals, which include urban hospitals serving large numbers of low-income, uninsured, and otherwise vulnerable populations, have historically faced greater financial strains than hospitals that serve more affluent populations. These strains can affect hospitals' quality of care, perhaps resulting in worse outcomes that are commonly used as indicators of care quality-mortality and readmission rates. We compared risk-standardized rates of both of these clinical outcomes among fee-for-service Medicare beneficiaries admitted for acute myocardial infarction, heart failure, or pneumonia. These beneficiaries were admitted to urban hospitals within Metropolitan Statistical Areas that contained at least one safety-net and at least one non-safety-net hospital. We found that outcomes varied across the urban areas for both safety-net and non-safety-net hospitals for all three conditions. However, mortality and readmission rates were broadly similar, with non-safety-net hospitals outperforming safety-net hospitals on average by less than one percentage point across most conditions. For heart failure mortality, there was no difference between safety-net and non-safety-net hospitals. These findings suggest that safety-net hospitals are performing better than many would have expected.
authors.affiliation: Section of General Internal Medicine at Yale University's School of Medicine in New Haven, Connecticut, USA. joseph.ross@yale.edu
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Ross
authors.forename: Susannah M
authors.initials: SM
authors.lastname: Bernheim
authors.forename: Zhenqiu
authors.initials: Z
authors.lastname: Lin
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Drye
authors.forename: Jersey
authors.initials: J
authors.lastname: Chen
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000368:Aged; D018588:Fee-for-Service Plans / Q000592:standards; D006297:Health Services Accessibility; D006333:Heart Failure / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006786:Hospitals, Urban / Q000592:standards*; D006801:Humans; D017057:Medically Uninsured; D006278:Medicare; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D010359:Patient Readmission / Q000706:statistics & numerical data; D011014:Pneumonia / Q000401:mortality / Q000628:therapy; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000592:standards*; D014481:United States