Surgical Patient Safety Outcomes in Critical Access Hospitals: How Do They Compare?

Nabil Natafgi; Jure Baloh; Paula Weigel; Fred Ullrich; Marcia M Ward

doi:10.1111/jrh.12176

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Surgical Patient Safety Outcomes in Critical Access Hospitals: How Do They Compare?

Journal article

Peer reviewed

Surgical Patient Safety Outcomes in Critical Access Hospitals: How Do They Compare?

Nabil Natafgi, Jure Baloh, Paula Weigel, Fred Ullrich and Marcia M Ward

The Journal of rural health, Vol.33(2), pp.117-126

04/2017

DOI: 10.1111/jrh.12176

PMID: 26880145

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Abstract

The aim of the study was to examine whether Critical Access Hospitals (CAHs), the predominant type of hospital in small and isolated rural areas, perform better than, the same as, or worse than Prospective Payment System (PPS) hospitals on measures of quality. The Healthcare Cost and Utilization Project State Inpatient Databases and American Hospital Association annual survey data were used for analyses. A total of 35,674 discharges from 136 nonfederal general hospitals with fewer than 50 beds were included in the analyses: 14,296 from 100 CAHs and 21,378 from 36 PPS hospitals. Outcome measures included 6 bivariate indicators of adverse events (including complications) of surgical care developed from the Agency for Healthcare Research and Quality's Patient Safety Indicators. Multiple logistic regression models were developed to examine the relationship between hospital adverse events and CAH status. Compared with PPS hospitals, CAHs are significantly less likely to have any observed (unadjusted) adverse event on 4 of the 6 indicators. After adjusting for patient mix and hospital characteristics, CAHs perform better on 3 of the 6 indicators. Accounting for the number of discharges eliminated the differences between CAHs and PPS hospitals in the likelihood of adverse events across all indicators except one. The study suggests there are no differences in surgical patient safety outcomes between CAHs and PPS hospitals of comparable size. This reinforces the central role of CAHs in providing quality surgical care to populations in rural and isolated areas, and underscores the importance of strategies to sustain rural surgery infrastructure.

Hospitals, Rural - standards

Prospective Payment System - statistics & numerical data

Surgical Procedures, Operative - mortality

United States

Humans

Patient Safety - statistics & numerical data

Logistic Models

Surgical Procedures, Operative - statistics & numerical data

Chi-Square Distribution

Quality Indicators, Health Care - statistics & numerical data

Surgical Procedures, Operative - standards

Patient Safety - standards

Hospitals, Rural - statistics & numerical data

Health Services Accessibility - standards

Details

Title: Subtitle: Surgical Patient Safety Outcomes in Critical Access Hospitals: How Do They Compare?
Creators: Nabil Natafgi - Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
Jure Baloh - Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
Paula Weigel - Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
Fred Ullrich - Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
Marcia M Ward - Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
Resource Type: Journal article
Publication Details: The Journal of rural health, Vol.33(2), pp.117-126
Publisher: England
DOI: 10.1111/jrh.12176
PMID: 26880145
ISSN: 0890-765X
eISSN: 1748-0361
Grant note: DOI: 10.13039/100000102, name: Health Resources and Services Administration, award: U1C RH20419
Language: English
Date published: 04/2017
Academic Unit: Health Management and Policy; Internal Medicine
Record Identifier: 9984063141002771

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