Measuring Emergency Care Survival: The Implications of Risk-Adjusting for Race and Poverty

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
Kimon L H IoannidesM Kit Delgado

Abstract

We determined the impact of including race, ethnicity, and poverty in risk adjustment models for emergency care sensitive conditions mortality that could be used for hospital pay-for-performance initiatives. We hypothesized that adjusting for race, ethnicity, and poverty would bolster rankings for hospitals that cared for a disproportionate share of non-white, Hispanic, or poor patients. We performed a cross-sectional analysis patients admitted from the emergency department to 157 hospitals in Pennsylvania with trauma, sepsis, stroke, cardiac arrest, and ST-elevation myocardial infarction. We used multivariable logistic regression models to predict in-hospital mortality. We determined the predictive accuracy of adding patient race and ethnicity (dichotomized as non-Hispanic white vs. all other Hispanic or non-white patients) and poverty (uninsured, on Medicaid, or lowest income quartile zip code vs. all others) to other patient-level covariates. We then ranked each hospital on observed-to-expected mortality, with and without race, ethnicity, and poverty in the model, and examined characteristics of hospitals with large changes between models. The overall mortality rate among 170,750 inpatients was 6.9%. Mortality was significan...Continue Reading

References

Jan 1, 1997·Annual Review of Public Health·N KriegerN E Moss
Feb 7, 1998·Medical Care·A ElixhauserR M Coffey
Oct 8, 1999·The New England Journal of Medicine·E E CalleC W Heath
Apr 20, 2000·The New England Journal of Medicine·J H PopeH P Selker
Jun 6, 2003·Health Services Research·Yujing Shen
Oct 12, 2005·Archives of Internal Medicine·Robin P HertzElijah Saunders
Apr 12, 2007·Health Affairs·Lawrence P CasalinoDiana Ramos
May 23, 2007·Medical Care·L Elizabeth GoldmanR Adams Dudley
Sep 13, 2007·Health Affairs·Marion E Lewin, Raymond J Baxter
May 15, 2008·JAMA : the Journal of the American Medical Association·Rachel M WernerR Adams Dudley
Feb 3, 2009·Health Services Management Research : an Official Journal of the Association of University Programs in Health Administration·Daniel L Friesner, Robert Rosenman
Jan 5, 2010·Annals of Emergency Medicine·Brendan G CarrCarolyn Clancy
Jun 24, 2010·JAMA : the Journal of the American Medical Association·Florian B MayrDerek C Angus
Apr 8, 2011·Health Affairs·Rachel M WernerDaniel Polsky
Apr 9, 2011·American Heart Journal·Raina M MerchantPeter W Groeneveld
May 7, 2011·Emergency Medicine Journal : EMJ·Elizabeth Ty WildeJoyce C Pressley
May 19, 2011·JAMA : the Journal of the American Medical Association·Renee Y HsiaYu-Chu Shen
Oct 16, 2012·Journal of the American College of Surgeons·Craig D NewgardAvery B Nathens
Nov 3, 2012·The Journal of Trauma and Acute Care Surgery·Vincent P DuronDaithi S Heffernan
Feb 23, 2013·BMJ : British Medical Journal·John E WennbergH Gilbert Welch
Dec 5, 2013·Health Affairs·Jeremiah D SchuurJesse M Pines
Dec 27, 2013·The New England Journal of Medicine·Andrew M Ryan
Jan 29, 2014·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Amelia K BoehmeSheryl Martin-Schild
Mar 15, 2014·The Journal of Trauma and Acute Care Surgery·Renee Y HsiaArthur L Kellermann
Jul 1, 2014·Neurology·James F BurkeLesli E Skolarus
Jul 17, 2014·JAMA : the Journal of the American Medical Association·Ashish K Jha, Alan M Zaslavsky
Dec 3, 2014·American Journal of Preventive Medicine·Craig D HoldenRada K Dagher
Dec 4, 2014·The Journal of Ambulatory Care Management·Richard L FullerJohn S Hughes
Jan 27, 2015·The New England Journal of Medicine·Sylvia M Burwell
Mar 3, 2015·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Prasanthi GovindarajanS Claiborne Johnston
Mar 10, 2015·The Journal of Political Economy·Joseph DoyleSamuel Kleiner
Apr 18, 2015·Journal of the American Society of Nephrology : JASN·John KalbfleischYi Li
May 20, 2015·Circulation·Colleen K McIlvennanLarry A Allen
Jun 28, 2015·Annals of Emergency Medicine·Benjamin C SunK John McConnell
Jul 2, 2015·JAMA : the Journal of the American Medical Association·Lance B BeckerRobert Graham

❮ Previous
Next ❯

Citations

Feb 20, 2020·AEM Education and Training·Bisan A SalhiBernard L Lopez
Apr 30, 2021·Advanced Emergency Nursing Journal·Camille Brockett-WalkerSheryl Heron

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.