U.S. Territories Have Higher Mortality Rates Than States

Hospitals in territories have increased 30-day readmission rates for AMI and pneumonia

WEDNESDAY, June 29 (HealthDay News) -- Hospitals in the U.S. territories have significantly higher risk-standardized all-cause mortality rates (RSMR) and lower performance on every core process measure than hospitals in the U.S. states, according to a study published online June 27 in the Archives of Internal Medicine.

Marcella Nunez-Smith, M.D., M.H.S., from the Yale University School of Medicine in New Haven, Conn., and colleagues compared the performance of 57 hospitals in the territories and 4,799 stateside hospitals in the United States. Nonfederal hospitals that discharged Medicare fee-for-service patients with acute myocardial infarction (AMI), heart failure, or pneumonia from 2005 to 2008 were included in the analysis. The RSMR and risk-standardized all-cause readmission rates (RSRR) were compared between hospitals in the territories and stateside hospitals, after adjusting for hospital characteristics and core process measure performance.

The investigators found that the U.S. territories had significantly higher hospital mean 30-day RSMR for AMI (18.8 versus 16.0 percent), heart failure (12.3 versus 10.8 percent), and pneumonia (14.9 versus 11.4 percent) than U.S. state hospitals. U.S. territories had significantly higher hospital mean 30-day RSRRs for AMI (20.6 versus 19.8 percent) and pneumonia (19.4 versus 18.4 percent), but not for heart failure (25.5 versus 24.5 percent). In the U.S. territories, the higher RSMRs remained statistically significant after adjusting for hospital characteristics and core process measure performance. Hospitals in the U.S. territories had significantly lower performance on all core process measures.

"Compared with hospitals in the U.S. states, hospitals in the U.S. territories have significantly higher 30-day mortality rates and lower performance on every core process measure for patients discharged after AMI, heart failure, and pneumonia," the authors write.

Two of the study authors developed RSMRs and RSRRs for AMI, heart failure, and pneumonia under contract with the Colorado Foundation for Medical Care, and one disclosed a financial relationship with United Healthcare.

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