Development, implementation, and use of an "equity lens" integrated into an institutional quality scorecard.
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ABSTRACT:
SUBMITTER: Connolly M
PROVIDER: S-EPMC8324221 | biostudies-literature | 2021 Jul
REPOSITORIES: biostudies-literature
Publications
Development, implementation, and use of an "equity lens" integrated into an institutional quality scorecard.
Connolly Mark M Selling Mary Kate MK Cook Scott S Williams James S JS Chin Marshall H MH Umscheid Craig A CA
Journal of the American Medical Informatics Association : JAMIA 20210701 8
Few healthcare provider organizations systematically track their healthcare equity, and fewer enable direct interaction with such data by their employees. From May to August 2019, we enhanced the data architecture and reporting functionality of our existing institutional quality scorecard to allow direct comparisons of quality measure performance by gender, age, race, ethnicity, language, zip code, and payor. The Equity Lens was made available to over 4000 staff in September 2019 for 82 institut ...[more]
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Project description:Purpose of reviewThe objective of this scoping review is to use a health equity lens to understand the extent and type of evidence that exists about the use of electronic nicotine delivery systems (ENDS) based on socioecological understandings of health influences (i.e., the US National Institute of Minority Health and Health Disparities' (NIMHD) Research Framework). The research question guiding the review was as follows: What is the range and scope of research that exists to help characterize health disparities related to ENDS use?Recent findingsNinety-eight articles published between 2019 and 2022 often examined racial/ethnic differences in ENDS use; however, other demographic characteristics, domains of influence across the life course, and levels of influence beyond individuals were rarely considered. As most studies were derived from large-scale, cross-sectional US national surveys, few longitudinal studies or intervention trials were published.SummaryThe use of the NIMHD framework to analyze recent literature helped identify research patterns and gaps that may be important to recognize for optimizing population health strategies to advance health equity. Future research on non-individual level factors influencing ENDS, interventions to effectively use ENDS for combustible cigarette cessation, and subpopulations susceptible to dual use may enhance existing science. Monitoring research using the NIMHD research framework can help researchers and policy makers to identify and when appropriate, prioritize support for overlooked but important research questions.
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Project description:ImportanceRigorous evidence describing the relationship between private equity acquisition and changes in hospital spending and quality is currently lacking.ObjectiveTo examine changes in hospital income, use, and quality measures that may be associated with private equity acquisition.Design, setting, and participantsThis cohort study identified 204 hospitals acquired by private equity firms from 2005 to 2017 and 532 matched hospitals not acquired by private equity. Using a difference-in-differences design, this study evaluated changes in net income, charges, charge to cost ratios, case mix index (a measure of reported illness burden), share of discharges for patients with Medicare or Medicaid coverage, discharges per year, and aggregate hospital quality measures associated with private equity acquisition through 3 years after acquisition, adjusted for case mix, hospital beds, calendar year, and adjustment for multiple hypothesis testing. In subgroup analyses, changes in outcomes for private equity-owned Hospital Corporation of America (HCA) hospitals and non-HCA hospitals relative to matched controls were assessed.Primary outcomes and measuresEight hospital income and use measures and 3 aggregate hospital quality measures were examined.ResultsRelative to 532 control hospitals, the 204 private equity-acquired hospitals showed a mean increase of $2 302 391 (95% CI, $956 660-$3 648 123; P = .009) in annual net income, an increase of $407 (95% CI, $296-$518; P < .001) in total charge per inpatient day, an increase of 0.61 (95% CI, 0.48-0.73; P < .001) in emergency department charge to cost ratio, an increase of 0.31 (95% CI, 0.26-0.37; P < .001) in total charge to cost ratio, an increase of 0.02 (95% CI, 0.01-0.02; P = .007) in case mix index, and a decrease of 0.96% (95% CI, 0.46%-1.45%; P = .002) in share of Medicare discharges. Medicaid's share of discharges (-0.16%; 95% CI, -0.86% to 0.53%; P > .99) and total hospital discharges (98; 95% CI, -54 to 250; P > .99) did not change differentially in a statistically significant manner. The aggregate quality score for acute myocardial infarction increased by 3.3% (95% CI, 1.6%-5.0%; P = .002), and the aggregate score for pneumonia increased by 2.9% (95% CI, 1.8%-3.9%; P < .001) in private equity-acquired hospitals relative to controls. The aggregate score for heart failure (1.3%; 95% CI, -0.2% to 2.7%; P = .92) did not differentially change in a statistically significant manner. In subgroup analyses, HCA hospitals showed similar findings to the entire sample. Among non-HCA hospitals, the only statistically significant relative changes were the increase in the emergency department charge to cost ratio (0.30; 95% CI, 0.12-0.48; P = .02) and the decrease in Medicare's share (-1.15%; 95% CI, -1.88% to -0.43%; P = .02). Non-HCA hospitals showed a decrease in the aggregate heart failure score (-3.3%; 95% CI, -5.3% to -1.3%; P = .01) and no statistically significant changes in the aggregate score for acute myocardial infarction (2.4%; 95% CI, -0.7% to 5.4%; P > .99) or pneumonia (0.2%; 95% CI, -1.4% to 1.7%; P > .99).Conclusions and relevanceHospitals acquired by private equity were associated with larger increases in net income, charges, charge to cost ratios, and case mix index as well as with improvement in some quality measures after acquisition relative to nonacquired controls. Heterogeneity in some findings was observed between HCA and non-HCA hospitals.
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