title: Doing well by doing good: linking access with quality.
abstract: BACKGROUND
  We hypothesize that medical centers that prioritize altruism can also deliver superior quality care.
  
  
  METHODS
  Data were obtained from California's Office of Statewide Health Planning and Development, Medicare Hospital Compare, and the Joint Commission US Census Bureau's American Community Survey. Outcomes were measured using summary statistics, regression analysis, and quality indices. Total discounted revenue/total revenue (TDR/TR) served as a proxy for altruistic care.
  
  
  RESULTS
  In nonprofit hospitals, TDR/TR positively correlated with 5 quality indices including pneumonia (P < .001), heart failure (P = .05), and overall surgical process of care (P = .009). Hospital size predicted higher quality surgical process (P = .06, 201 to 300 beds; P = .01, >301 beds), hospital teaching status demonstrated positive correlation (β = .048, P = .69), and poverty was negatively correlated (β = -.00072, P = .89). Positive TDR/TR did not adversely affect mortality or readmission rates (P = .52).
  
  
  CONCLUSIONS
  TDR/TR predicts quality in nonprofit hospitals without increasing mortality and readmission. Altruistic motivation may be associated with the delivery of higher quality surgical care.
authors.affiliation: Department of Surgery, Loyola University Medical Center, Stritch School of Medicine, 2160 South First Avenue, Maywood, IL 60153, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Chang
authors.affiliation: Department of Surgery, Loyola University Medical Center, Stritch School of Medicine, 2160 South First Avenue, Maywood, IL 60153, USA.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Kuo
authors.affiliation: Department of Surgery, Loyola University Medical Center, Stritch School of Medicine, 2160 South First Avenue, Maywood, IL 60153, USA. Electronic address: pwai@lumc.edu.
authors.forename: Philip Y
authors.initials: PY
authors.lastname: Wai
mesh_terms: D000533:Altruism; D013502:General Surgery / Q000592:standards*; D006761:Hospitals / Q000592:standards*; D006801:Humans; D019984:Quality Indicators, Health Care / Q000592:standards*; D014481:United States
keywords: Access; Altruism; Outcomes; Quality; Surgery