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State policies can influence the safety of hospitalized children via Medicaid payments

The care and safety of hospitalized children is influenced by the policies of State governments through their prominent role as payer of hospital pediatric services. For example, the likelihood of a pediatric adverse event is much greater in hospitals in markets in which Medicaid payers face relatively little competition.

The researchers examined the association between Medicaid patient, hospital, and market characteristics and the likelihood of two adverse events, decubitus ulcers (severe pressure sores) and accidental puncture or laceration (also called patient safety indicators, PSIs). They used pediatric discharge data from the 1999 to 2001 State Inpatient Databases from the AHRQ Healthcare Cost and Utilization Project, which they merged with American Hospital Association annual survey data, and Medicaid data from Florida, New York, and Wisconsin.

Overall, Medicaid patients experienced two fewer adverse events than privately insured patients for every 10,000 discharges for each type of patient at risk, a significant difference. However, at the hospital level, hospitals with higher Medicaid service levels, either in terms of the proportion of Medicaid patients or in Disproportionate Share payments received, had higher PSI rates.

In multivariate analysis, patients in markets in which Medicaid payers faced relatively little competition were 60 percent more likely to experience a PSI, while patients in markets in which hospitals faced relatively little competition were 31 percent less likely to experience an adverse event. Medicaid characteristics (which differed among the three states) were not significantly associated with the incidence of a PSI.

See "Medicaid markets and pediatric patient safety in hospitals," by Richard B. Smith, Ph.D., Robyn Cheung, R.N., Ph.D., Dr. Owens, and others, in the October 2007 HSR: Health Services Research 42(5), pp. 1981-1998.

Reprints (AHRQ Publication No. 08-R018) are available from the AHRQ Publications Clearinghouse.

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