Pre-COVID-19 Hospital Quality and Hospital Response to COVID-19: Examining Associations between Risk-Adjusted Mortality for Patients Hospitalised with COVID-19 and Pre-COVID-19 Hospital Quality

Authors

Doris Peter
Shu-Xia Li
Yongfei Wang
Jing Zhang
Jacqueline Grady
Kerry McDowell
Erica Norton
Zhenqiu Lin
Susannah Bernheim
Arjun K Venkatesh
Lee A Fleisher
Michelle Schreiber
Lisa G Suter
Elizabeth W Triche

Publication Date

3-29-2024

Journal

BMJ Open

Abstract

OBJECTIVES: The extent to which care quality influenced outcomes for patients hospitalised with COVID-19 is unknown. Our objective was to determine if prepandemic hospital quality is associated with mortality among Medicare patients hospitalised with COVID-19.

DESIGN: This is a retrospective observational study. We calculated hospital-level risk-standardised in-hospital and 30-day mortality rates (risk-standardised mortality rates, RSMRs) for patients hospitalised with COVID-19, and correlation coefficients between RSMRs and pre-COVID-19 hospital quality, overall and stratified by hospital characteristics.

SETTING: Short-term acute care hospitals and critical access hospitals in the USA.

PARTICIPANTS: Hospitalised Medicare beneficiaries (Fee-For-Service and Medicare Advantage) age 65 and older hospitalised with COVID-19, discharged between 1 April 2020 and 30 September 2021.

INTERVENTION/EXPOSURE: Pre-COVID-19 hospital quality.

OUTCOMES: Risk-standardised COVID-19 in-hospital and 30-day mortality rates (RSMRs).

RESULTS: In-hospital (n=4256) RSMRs for Medicare patients hospitalised with COVID-19 (April 2020-September 2021) ranged from 4.5% to 59.9% (median 18.2%; IQR 14.7%-23.7%); 30-day RSMRs ranged from 12.9% to 56.2% (IQR 24.6%-30.6%). COVID-19 RSMRs were negatively correlated with star rating summary scores (in-hospital correlation coefficient -0.41, p

CONCLUSIONS: Hospitals with better prepandemic quality may have care structures and processes that allowed for better care delivery and outcomes during the COVID-19 pandemic. Understanding the relationship between pre-COVID-19 hospital quality and COVID-19 outcomes will allow policy-makers and hospitals better prepare for future public health emergencies.

Keywords

Aged, Humans, COVID-19, Hospital Mortality, Hospitals, Medicare, Pandemics, United States, Retrospective Studies

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Supplementary Materials

PMID: 38553067