Dataset Information

Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians.

ABSTRACT: Importance:Studies have found differences in practice patterns between male and female physicians, with female physicians more likely to adhere to clinical guidelines and evidence-based practice. However, whether patient outcomes differ between male and female physicians is largely unknown. Objective:To determine whether mortality and readmission rates differ between patients treated by male or female physicians. Design, Setting, and Participants:We analyzed a 20% random sample of Medicare fee-for-service beneficiaries 65 years or older hospitalized with a medical condition and treated by general internists from January 1, 2011, to December 31, 2014. We examined the association between physician sex and 30-day mortality and readmission rates, adjusted for patient and physician characteristics and hospital fixed effects (effectively comparing female and male physicians within the same hospital). As a sensitivity analysis, we examined only physicians focusing on hospital care (hospitalists), among whom patients are plausibly quasi-randomized to physicians based on the physician's specific work schedules. We also investigated whether differences in patient outcomes varied by specific condition or by underlying severity of illness. Main Outcomes and Measures:Patients' 30-day mortality and readmission rates. Results:A total of 1?583?028 hospitalizations were used for analyses of 30-day mortality (mean [SD] patient age, 80.2 [8.5] years; 621?412 men and 961?616 women) and 1?540?797 were used for analyses of readmission (mean [SD] patient age, 80.1 [8.5] years; 602?115 men and 938?682 women). Patients treated by female physicians had lower 30-day mortality (adjusted mortality, 11.07% vs 11.49%; adjusted risk difference, -0.43%; 95% CI, -0.57% to -0.28%; P?

SUBMITTER: Tsugawa Y

PROVIDER: S-EPMC5558155 | biostudies-literature | 2017 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians.

Tsugawa Yusuke Y Jena Anupam B AB Figueroa Jose F JF Orav E John EJ Blumenthal Daniel M DM Jha Ashish K AK

JAMA internal medicine 20170201 2

<h4>Importance</h4>Studies have found differences in practice patterns between male and female physicians, with female physicians more likely to adhere to clinical guidelines and evidence-based practice. However, whether patient outcomes differ between male and female physicians is largely unknown.<h4>Objective</h4>To determine whether mortality and readmission rates differ between patients treated by male or female physicians.<h4>Design, setting, and participants</h4>We analyzed a 20% random sa ...[more]

PMID: 27992617

Similar Datasets

Project description:ImportanceThe Affordable Care Act has led to US national reductions in hospital 30-day readmission rates for heart failure (HF), acute myocardial infarction (AMI), and pneumonia. Whether readmission reductions have had the unintended consequence of increasing mortality after hospitalization is unknown.ObjectiveTo examine the correlation of paired trends in hospital 30-day readmission rates and hospital 30-day mortality rates after discharge.Design, setting, and participantsRetrospective study of Medicare fee-for-service beneficiaries aged 65 years or older hospitalized with HF, AMI, or pneumonia from January 1, 2008, through December 31, 2014.ExposureThirty-day risk-adjusted readmission rate (RARR).Main outcomes and measuresThirty-day RARRs and 30-day risk-adjusted mortality rates (RAMRs) after discharge were calculated for each condition in each month at each hospital in 2008 through 2014. Monthly trends in each hospital's 30-day RARRs and 30-day RAMRs after discharge were examined for each condition. The weighted Pearson correlation coefficient was calculated for hospitals' paired monthly trends in 30-day RARRs and 30-day RAMRs after discharge for each condition.ResultsIn 2008 through 2014, 2 962 554 hospitalizations for HF, 1 229 939 for AMI, and 2 544 530 for pneumonia were identified at 5016, 4772, and 5057 hospitals, respectively. In January 2008, mean hospital 30-day RARRs and 30-day RAMRs after discharge were 24.6% and 8.4% for HF, 19.3% and 7.6% for AMI, and 18.3% and 8.5% for pneumonia. Hospital 30-day RARRs declined in the aggregate across hospitals from 2008 through 2014; monthly changes in RARRs were -0.053% (95% CI, -0.055% to -0.051%) for HF, -0.044% (95% CI, -0.047% to -0.041%) for AMI, and -0.033% (95% CI, -0.035% to -0.031%) for pneumonia. In contrast, monthly aggregate changes across hospitals in hospital 30-day RAMRs after discharge varied by condition: HF, 0.008% (95% CI, 0.007% to 0.010%); AMI, -0.003% (95% CI, -0.005% to -0.001%); and pneumonia, 0.001% (95% CI, -0.001% to 0.003%). However, correlation coefficients in hospitals' paired monthly changes in 30-day RARRs and 30-day RAMRs after discharge were weakly positive: HF, 0.066 (95% CI, 0.036 to 0.096); AMI, 0.067 (95% CI, 0.027 to 0.106); and pneumonia, 0.108 (95% CI, 0.079 to 0.137). Findings were similar in secondary analyses, including with alternate definitions of hospital mortality.Conclusions and relevanceAmong Medicare fee-for-service beneficiaries hospitalized for heart failure, acute myocardial infarction, or pneumonia, reductions in hospital 30-day readmission rates were weakly but significantly correlated with reductions in hospital 30-day mortality rates after discharge. These findings do not support increasing postdischarge mortality related to reducing hospital readmissions.

Project description:BackgroundMedicare's Hospital Readmissions Reduction Program reports risk-standardized readmission rates for traditional Medicare but not Medicare Advantage beneficiaries.ObjectiveTo compare readmission rates between Medicare Advantage and traditional Medicare.DesignRetrospective cohort study linking the Medicare Provider Analysis and Review (MedPAR) file with the Healthcare Effectiveness Data and Information Set (HEDIS).Setting4748 U.S. acute care hospitals.PatientsPatients aged 65 years or older hospitalized for acute myocardial infarction (AMI) (n = 841 613), congestive heart failure (CHF) (n = 1 458 652), or pneumonia (n = 2 020 365) between 2011 and 2014.Measurements30-day readmissions.ResultsAmong admissions for AMI, CHF, and pneumonia identified in MedPAR, 29.2%, 38.0%, and 37.2%, respectively, did not have a corresponding record in HEDIS. Of these, 18.9% for AMI, 23.7% for CHF, and 18.3% for pneumonia resulted in a readmission that was identified in MedPAR. However, among index admissions appearing in HEDIS, 14.4% for AMI, 18.4% for CHF, and 13.9% for pneumonia resulted in a readmission. Patients in Medicare Advantage had lower unadjusted readmission rates than those in traditional Medicare for all 3 conditions (16.6% vs. 17.1% for AMI, 21.4% vs. 21.7% for CHF, and 16.3% vs. 16.4% for pneumonia). However, after standardization, patients in Medicare Advantage had higher readmission rates than patients in traditional Medicare for AMI (17.2% vs. 16.9%; difference, 0.3 percentage point [95% CI, 0.1 to 0.5 percentage point]), CHF (21.7% vs. 21.4%; difference, 0.3 percentage point [CI, 0.2 to 0.5 percentage point]), and pneumonia (16.5% vs. 16.0%; difference, 0.5 percentage point [95% CI, 0.4 to 0.6 percentage point]). Rate differences increased between 2011 and 2014.LimitationPotential unobserved differences between populations.ConclusionThe HEDIS data underreported hospital admissions for 3 common medical conditions, and readmission rates were higher among patients with underreported admissions. Medicare Advantage beneficiaries had higher risk-adjusted 30-day readmission rates than traditional Medicare beneficiaries.Primary funding sourceNational Institute on Aging.

Project description:ImportanceHospitalized medical patients cared for by female physicians may have decreased mortality rates compared with patients of male physicians. However, this association has yet to be assessed outside of the US, and little is known about factors that may explain this difference.ObjectiveTo determine whether mortality, other hospital outcomes, and processes of care differed between the patients cared for by female and male physicians.Design setting and participantsThis retrospective cross-sectional study included patients admitted to general medical wards at 7 hospitals in Ontario, Canada, between April 1, 2010, and October 31, 2017. The association of physician gender with patient outcomes was examined while adjusting for hospital fixed effects, patient characteristics, physician characteristics, and processes of care. All patients were admitted to a general internal medicine service through the emergency department and were cared for by a general internist or family physician-hospitalist. Patients were excluded if length of stay was greater than 30 days or if the attending physician cared for less than 100 hospitalized general medicine patients over the study period. Statistical analyses were performed from October 15, 2020, to May 8, 2021.Main outcomes and measuresIn-hospital mortality, length of stay, intensive care unit admission, 30-day readmissions, and process-of-care measures (blood tests, medications, imaging, endoscopy, and interventional radiology services).ResultsA total of 171 625 hospitalized patients with a median age of 73 years (interquartile range, 56-84 years) were included (84 221 men [49.1%], 87 402 women [50.9%], and 2 patients with unspecified sex). Patients were cared for by 172 attending physicians (54 female physicians [31.4%] and 118 male physicians [68.6%]). In fully adjusted models, female physicians ordered more imaging tests, including computed tomography (adjusted difference, -1.70%; 95% CI, -2.78% to -0.61%; P = .002), magnetic resonance imaging (-0.88%; 95% CI, -1.37% to -0.38%; P = .001), and ultrasonography (-1.90%; 95% CI, -3.21% to -0.59%; P = .005). Patients treated by female physicians had lower in-hospital mortality (2256 of 46 772 patients [4.8%] vs 6452 of 124 853 patients [5.2%]). This difference persisted after adjustment for patient characteristics but was no longer statistically different after adjustment for other physician characteristics (adjusted difference, 0.29%; 95% CI, -0.08% to 0.65%; P = .12). The difference was similar after further adjustment for processes of care.Conclusions and relevanceIn this cross-sectional study of patients admitted to general medical units in Canada, patients cared for by female physicians had lower mortality rates than those treated by male physicians, adjusting for patient characteristics. This finding was nonsignificant after adjustment for other physician characteristics.

Project description:BACKGROUND & AIMS:Gastrointestinal bleeding results in significant morbidity, mortality, and healthcare costs in the United States. The Center for Medicare and Medicaid Services' payment reform programs assess quality and value based on rates of hospital readmission for patients with gastrointestinal bleeding, but they identify these patients using Medicare Severity Diagnosis Related Groups (MS-DRGs), which include many types of gastrointestinal bleeding and do not account for the clinical heterogeneity among these patients. We aimed to characterize heterogeneity in outcomes of subgroups of patients with gastrointestinal bleeding. METHODS:We performed was a cross-sectional, claims-based retrospective analysis of Medicare fee for service beneficiaries hospitalized for gastrointestinal bleeding in 2014 (159,000 hospitalizations). The primary outcome was unplanned readmission within 30 days of discharge from the hospital (30-day readmission). Secondary outcomes included length of stay, inpatient mortality, and death within 30 days of admission to the hospital (30-day mortality). Analyses were adjusted for age, sex, race, and Elixhauser comorbidities using logistic and Poisson regression, adjusting for clustering within hospitals. RESULTS:The 30-day readmission rate was 16.0%. Readmission rates varied among patients with different types of gastrointestinal bleeding, ranging from 13.5% for diverticular bleeding to 18.6% for small bowel bleeding. The mean length of stay was 4.2 days and 30-day mortality was 6.9% (ranging from 3.4% for diverticular bleeding to 12.1% for upper gastrointestinal bleeding not otherwise specified). When hospitalizations were stratified by MS-DRGs, the main source of variation in rates of readmission and mortality was MS-DRGs. CONCLUSIONS:In a retrospective analysis of Medicare fee for service beneficiaries hospitalized for gastrointestinal bleeding, we found that 16% of these patients are readmitted to the hospital. Rates of hospital readmission, length of stay, and mortality vary with type of gastrointestinal bleeding, but MS-DRGs account for the largest source of variation. Policies focused on quality and value should account for this heterogeneity.

Project description:BackgroundPatients with serious mental illness (i.e., SMI; bipolar disorder, major depressive disorder, and schizophrenia) are at increased risk of readmission, yet little is known about the extent to which readmission rates among these patients vary across hospitals. The purpose of this study was to examine the variation across hospitals in readmissions for patients with SMI and differences in the characteristics of hospitals with the highest and lowest adjusted readmission rates.MethodsWe conducted a cross-sectional analysis of pooled inpatient claims from 2013-2016. Mixed logit models with hospital random effects were used to estimate the hospital-level variance. The sample included patients with SMI from a 5% sample of fee-for-service Medicare beneficiaries.ResultsWe identified 2066 hospitals with at least 30 index admissions for Medicare beneficiaries with SMI. In multivariate analyses, factors most strongly associated with increased risk of readmission included substance use disorder (OR 2.311; p < 0.001) and end stage renal disease (OR 2.024; p < 0.001). Unadjusted readmission for hospitals at the 5th and 95th percentiles of performance were 7.05% and 15.24%, respectively, constituting an 8.2% difference. Adjusting for patient and community characteristics reduced the spread in readmission rates between the 5th and 95th percentiles of hospitals by 1.0% (i.e. to 7.2%). Hospitals in the lowest vs. highest quintiles of adjusted readmission rates were more likely to be teaching hospitals (11.1% vs. 16.7%; p < 0.05) and located in the South (37.7% vs. 40.4%) or Midwest (19.8% vs. 30.0%; p < 0.001 for region differences).ConclusionsThere is substantial hospital-level variation in readmission rates among patients with serious mental illness, even after adjusting for patient and community characteristics. This has implications for policy guiding investment in hospital-based services and community resources, to improve transitions of care for patients with SMI.

Dataset Information

Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians.

Publications

Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets