Introduction: In 2010, the Patient Protection and Affordable Care Act was passed to expand health insurance and improve the quality of health care in the United States. The Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services (CMS) hospital-acquired conditions (HACs) are now quality metrics tracked in healthcare institutions. The effects of insurance status on the incidence of PSIs and HACs were analyzed using the Nationwide Inpatient Sample (NIS) database from 2002-2011 for all brain tumor patients.
Methods: The NIS was queried for all hospitalizations between 2002 and 2011 involving patients with brain tumors. The incidence for each PSI and HAC was determined by searching the hospital records for ICD-9 codes. The independent variable was primary payer status. Because of the age restriction with Medicare, primary payer comparisons were made between Medicaid/self-pay and private insurance. The incidence of patient harm events was calculated and a logistic regression model was created to estimate the effects of insurance on PSIs, HACs, and patient outcomes.
Results: Overall, 113,797 PSIs occurred in 548,727 brain tumor patients, for an incidence of 20.7%. Only 15,810 HACs occurred, for an overall incidence of 2.9%. Medicaid/self-pay patients had a higher PSI incidence compared to private insurance patients (20.6% versus 18.6%, p<0.0001). The Medicaid/self-pay patients also had a higher incidence of HACs (2.2% versus 1.9%, p<0.0001). The increased incidence of PSIs and HACs correlated with increased length of stay and worse discharge outcomes in the Medicaid/self-pay patient population.
Conclusions: Significant variability exists in the incidence of PSIs and HACs in brain tumor patients based on insurance status. The cause of these differences should be studied prospectively to begin the process of improving quality metrics in vulnerable patient populations.
Patient Care: This session brings to light the current socioeconomic disparities facing brain tumor patients. Participants of this session will be able to identify potential areas of improvement in the care of their own patients.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Understand the importance of payer status on patient care in the united states 2) Understand the upcoming changes with the affordable care act 3) Identify possible socioeconomic disparities in their own practice
References: 1. Agency for Healthcare Research and Quality: Quality Indicator User Guide: Patient Safety Indicators (PSI) Composite Measures Version 4.4. , in. http://qualityindicators.ahrq.gov/Modules/PSI_TechSpec.aspx, 2013, Vol 2013
2. Centers for Medicare & Medicaid Services: Hospital Acquired Conditions, in. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/Hospital-Acquired_Conditions.html: Centers for Medicare & Medicaid Services, 2013, Vol 2013
3. Curry WT, Jr., Carter BS, Barker FG, 2nd: Racial, ethnic, and socioeconomic disparities in patient outcomes after craniotomy for tumor in adult patients in the United States, 1988-2004. Neurosurgery 66:427-437; discussion 437-428, 2010
4. Rahman M, Neal D, Fargen KM, Hoh BL: Establishing standard performance measures for adult brain tumor patients: a Nationwide Inpatient Sample database study. Neuro Oncol 15:1580-1588, 2013