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Hospital system type affects mortality rates

Research Activities, August 2009, No. 348

Most U.S. hospitals belong to one of five main types of health systems: centralized, centralized physician/insurance, modern centralized, decentralized, and independent. Hospitals belonging to a centralized health system (CHS) have the lowest mortality rates for acute myocardial infarction (AMI, heart attack), congestive heart failure, and pneumonia, concludes a new study. A CHS centrally organizes hospital services, physician arrangements, and insurance product development, and provides them at the system level. Most often, such systems are found in cities and other areas where hospitals are in close proximity to each other, notes Gloria J. Bazzoli, Ph.D., of Virginia Commonwealth University. She and fellow researchers gathered 6 years of data from 11 states and a variety of sources.

The researchers used four clinical Agency for Healthcare Research and Quality (AHRQ) Inpatient Quality Indicators: specific risk-adjusted in-hospital mortality rates for AMI, congestive heart failure, pneumonia, and stroke. All are leading causes of death in the United States. Hospitals affiliated with a CHS had lower mortality rates for the first three conditions. Independent hospital systems had better heart attack quality outcomes than centralized physician/insurance systems and moderately centralized health systems.

The researchers found no difference in inpatient mortality for stroke among the five different system types. However, stroke mortality rose as the hospital size increased. Hospitals with increased pneumonia mortality rates were those with for-profit ownership status. According to the researchers, a CHS is more likely to provide higher quality inpatient care than any other system type. CHS hospitals tend to be larger, associated with medical schools, and less likely to operate as a for-profit institution. The study was supported by the Agency for Healthcare Research and Quality (HS13094).

See "Variations in inpatient mortality among hospitals in different system types, 1995 to 2000," by Askar S. Chukmaitov, M.D., Ph.D., Dr. Bazzoli, David W. Harless, Ph.D., and others, in the April 2009 Medical Care 47(4), pp. 466-473.

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Page last reviewed August 2009
Internet Citation: Hospital system type affects mortality rates: Research Activities, August 2009, No. 348. August 2009. Agency for Healthcare Research and Quality, Rockville, MD.