Inpatient care intensity and patients' ratings of their hospital experiences

Health Affairs

Volumn 28, Issue 1, 2009, Pages 103-112

  Wennberg, John E ^a   Bronner, Kristen ^a   Skinner, Jonathan S ^b   Fisher, Elliott S ^a,c,d   Goodman, David C ^c,e  

^a DARTMOUTH INSTITUTE FOR HEALTH POLICY AND CLINICAL PRACTICE   (United States)

^b Dartmouth College   (United States)

^c DARTMOUTH MEDICAL SCHOOL   (United States)

^d VA MEDICAL CENTER   (United States)

^e Center for Health Policy Research

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CHRONIC DISEASE; CHRONIC PATIENT; HEALTH CARE PERSONNEL; HOSPITAL CARE; HOSPITAL PATIENT; HOSPITALIZATION; HUMAN; INTENSIVE CARE UNIT; MEDICAL SPECIALIST; PATIENT REFERRAL; TOTAL QUALITY MANAGEMENT;

CHRONIC DISEASE; HEALTH CARE SURVEYS; HUMANS; INPATIENTS; INTERVIEWS AS TOPIC; PATIENT SATISFACTION; QUALITY OF HEALTH CARE; UNITED STATES;

EID: 59449091268     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.28.1.103     Document Type: Article

References (20)

1. J.E. Wennberg et al., Tracking the Care of Patients with Severe Chronic Illness: The Dartmouth Atlas of Health Care 2008 (Lebanon, N.H.: Dartmouth Institute for Health Policy and Clinical Practice, 2008).
2. K. Baicker and A. Chandra, "Medicare Spending, the Physician Workforce, and Beneficiaries' Quality of Care," Health Affairs 23 (2004): w184-w197 (published online 7 April 2004; 10.1377/hlthaff.w4.184).
3. J.E. Wennberg et al., "Evaluating the Efficiency of California Providers in Caring for Patients with Chronic Illnesses," Health Affairs 24 (2005): w526-w543 (published online 16 November 2005; 10.1377/hlthaff.w5.526);
4. and L.C. Baker, E.S. Fisher, and J.E. Wennberg, "Variations in Hospital Resource Use for Medicare and Privately Insured Populations in California," Health Affairs 27, no. 2 (2008): w123-w134 (published online 12 February 2008; 10.1377/hlthaff.27.2.w123).
5. See U.S. Department of Health and Human Services, Hospital Compare - A Quality Tool for Adults, Including People with Medicare, http://www.hospitalcompare.hhs.gov (accessed 22 October 2008).
6. For the methodology, see ibid.
7. The five performance measures for AMI are the percentage of eligible patients receiving (1) aspirin at time of admission; (2) aspirin at time of discharge; (3) angiotensin-converting enzyme (ACE) inhibitor for left ventricular dysfunction; (4) beta-blocker at admission; and (5) beta-blocker at discharge. The two CHF measures are the percentage of patients with (1) assessment of left ventricular function, and (2) ACE inhibitor for left ventricular dysfunction. For pneumonia, the three measures are the percentage of patients with (1) oxygenation assessment; (2) pneumococcal vaccination; and (3) timing of initial antibiotic therapy. The summary scores are equally weight-averaged for the items in each category. Hospital-specific summary scores are given only for those hospitals for which four of the five AMI measures and all of the CHF and pneumonia measures were based on twenty-five or more patients. See A.K. Jha et al., "Care in U.S. Hospitals - The Hospital Quality Alliance Program," New England Journal of Medicine 353, no. 3 (2005): 265-274.
8. The conditions, which include malignant cancer/leukemia, CHF, chronic pulmonary disease, dementia, diabetes with end organ damage, peripheral vascular disease, chronic renal failure, severe chronic liver disease, and coronary artery disease, are based on L.I. Iezzoni et al., "Chronic Conditions and Risk of In-Hospital Death," Health Services Research 29, no. 4 (1994): 435-460.
9. For the follow-back methodology, see Wennberg et al., "Evaluating the Efficiency of California Providers."
10. Wennberg et al., Tracking the Care of Patients.
11. See the Dartmouth Atlas Web site, http://www.dartmouthatlas.org.
12. 2 = 0.33; t-statistics for quality and HCI = 5.8 and 8.8, respectively). Thus, the perception of hospital quality by patients is associated independently with both process quality and the HCI index.
13. E.S. Fisher et al., "The Implications of Regional Variations in Medicare Spending, Part 1: Utilization of Services and the Quality of Care," Annals of Internal Medicine 138, no. 4 (2003): 273-287;
14. and E.S. Fisher et al., "The Implications of Regional Variations in Medicare Spending, Part 2: Health Outcomes and Satisfaction with Care," Annals of Internal Medicine 138, no. 4 (2003): 288-298.
15. See G.S. Becker and K.M. Murphy, "The Division of Labor, Coordination Costs, and Knowledge," Quarterly Journal of Economics 107, no. 4 (1992): 1137-1160.
16. B.E. Sirovich et al., "Regional Variations in Health Care Intensity and Physician Perceptions of Quality of Care," Annals of Internal Medicine 144, no. 9 (2006): 641-649.
17. For a review of the dimensions of care coordination, see T. Bodenheimer, "Coordinating Care - A Perilous Journey through the Health Care System," New England Journal of Medicine 358, no. 10 (2008): 1064-1071.
18. See P.B. Bach, D. Schrag, and C.B. Begg, "Resurrecting Treatment Histories of Dead Patients: A Study Design That Should Be Laid to Rest," Journal of the American Medical Association 292, no. 22 (2004): 2765-2770.
19. J.E. Wennberg et al., "Extending the P4P Agenda, Part 2: How Medicare Can Reduce Waste and Improve the Care of the Chronically Ill," Health Affairs 26, no. 6 (2007): 1575-1585;
20. and E.S. Fisher et al., "Creating Accountable Care Organizations: The Extended Medical Staff," Health Affairs 26, no. 1 (2007): w44-w57 (published online 5 December 2006; 10.1377/hlthaff.26.1.w44).