Text

theses

Background
Hospitals have been required to publicly report outcomes of care or costs for many years based on state level mandates. In 2003 the federal government began requiring similar public reporting for hospitals to be reimbursed by Medicare. The goal has been to allow consumer demand to drive quality improvement in patient care and to reduce the cost of care. This dissertation explores the effectiveness of such programs by evaluating inpatient mortality rates and the length of stay (LOS) in acute myocardial infarction and heart failure patients from 1988 through 2006 using publicly reported data and Health Care Utilization Project – Nationwide Inpatient Sample data.
Methods
First, an evaluation was completed to ensure no endogeneity existed with variables associated with the likelihood of implementing the mandated reporting at the state level and the outcomes of interest. A linear probability model was run with several state level factors as independent variables that were potentially associated with mandate implementation. Factors found to be significant in that model were incorporated into subsequent regression models. Second, regression models were developed to identify the association between the state level mandate and the outcomes of interest. Third, regression models were used to evaluate the association between federal mandates and the outcomes of interest. Linear probability models were used for the probability of dying while in the hospital and Poisson regression models were used for LOS.
Results
Factors that were potentially associated with the implementation of mandates were the state fiscal margin, the average hospital level LOS and the average inpatient mortality rates leading up to the implementation of the mandate. The implementation of state level mandates was associated with a decrease in the probability of dying while an inpatient and a decrease in the inpatient LOS for AMI and HF patients. The implementation of federal mandates was associated with an increase int the probability of dying while an inpatient and an increase in the inpatient LOS for AMI and HF patients. Federal mandates appeared to wash out the positive effect of state mandates in AMI patients.
Conclusion
Mandated hospital reporting can be effective, but be done at the most effective level of government respective level of government.

ETD_9547

Ph.D.

Includes bibliographical references

doi:10.7282/t3-0q4p-hd97

ETD doctoral

The author owns the copyright to this work.