Thinking globally and acting locally: Findings from the national healthcare quality and disparities report (NHQR-DR) on patient safety outcomes in the United States
Methods: Some 34 NHQR-DR patient safety measures are organized into 4 categories: Healthcare-Associated Infections (HAIs), Surgical Complications, Medication Complications, and Other Hospital Complications. The measures are stratified by race/ethnicity, age, gender, income, insurance, and hospital location. Significant differences are those with a p-value <0.05 (two-tailed test), and a minimum relative difference of >10% between the comparison and reference groups.
Findings: Healthcare-associated infections: In 2009, hospitals in medium metropolitan, small metropolitan, micropolitan and non-metropolitan had lower rates of postoperative sepsis than those in large fringe areas. In 2009, patients ages 45-64 (4.21 per 1000 hospital discharges) had higher catheter-related bloodstream infections than those ages 18-44 (2.14 per 1000 hospital discharges).
Surgical Complications: From 2000-2009, Non-Hispanic Whites, Non-Hispanic Blacks and Hispanics with private insurance had significantly lower rates of re-closure of postoperative abdominal wound dehiscence than did individuals with Medicaid. Medication Complications: In 2010, the percentage of hospital patients age 65 and over who had an adverse drug event associated with a hypoglycemic agent (11.2%) was significantly higher than it was for patients under age 65 (8.3%). Non-Hispanic Blacks had higher rates of hypoglycemic agent adverse events (12.7%) than did non-Hispanic Whites (9.5%).
Other Hospital Complications: From 2005-2009, the mortality rate for hospital admissions with low expected mortality was significantly higher for lower income adults than for higher income adults and the rate for males were more than twice the rate for females.
Conclusions: Disparities in HAIs and surgical, medication, and other hospital complications exist for individuals of lower socioeconomic status, racial minorities, older adults, males and hospitals located in large fringe areas. Programs like the Partnership for Patients should continue to provide focused policies and research that identify ways to improve the areas of concern highlighted in this evaluation.
Learning Areas:Provision of health care to the public
Demonstrate disparities in 4 areas of patients safety outcomes in the United States taken from the National Healthcare Quality and Disparities Report (NHQR-DR) database. Identify populations that need greater attention in receiving safer patient centered medical care in the United States. Describe 3 methods used in the NHQR-DR to assess disparities in patient safety quality measures.
Keyword(s): Quality Improvement, Medical Care
Qualified on the content I am responsible for because: For over three years I have been a member of the production team for National Healthcare Quality and Disparities Reports reporting of areas of healthcare such as patient safety, healthcare disparities and the overall quality of healthcare in the United States.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.