Hospital Performance, the Local Economy, and the Local Workforce: Findings from a US National Longitudinal Study

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Hospital Performance, the Local Economy, and the Local Workforce: Findings from a US National Longitudinal Study

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Title: Hospital Performance, the Local Economy, and the Local Workforce: Findings from a US National Longitudinal Study
Author: Blustein, Jan; Borden, William B.; Valentine, Melissa A

Note: Order does not necessarily reflect citation order of authors.

Citation: Blustein, Jan, William B. Borden, and Melissa Valentine. 2010. Hospital Performance, the Local Economy, and the Local Workforce: Findings from a US National Longitudinal Study. PLoS Medicine 7(6): e1000297.
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Abstract: Background: Pay-for-performance is an increasingly popular approach to improving health care quality, and the US
government will soon implement pay-for-performance in hospitals nationwide. Yet hospital capacity to perform (and
improve performance) likely depends on local resources. In this study, we quantify the association between hospital
performance and local economic and human resources, and describe possible implications of pay-for-performance for
socioeconomic equity.
Methods and Findings: We applied county-level measures of local economic and workforce resources to a national sample
of US hospitals (n = 2,705), during the period 2004–2007. We analyzed performance for two common cardiac conditions
(acute myocardial infarction [AMI] and heart failure [HF]), using process-of-care measures from the Hospital Quality Alliance
[HQA], and isolated temporal trends and the contributions of individual resource dimensions on performance, using
multivariable mixed models. Performance scores were translated into net scores for hospitals using the Performance
Assessment Model, which has been suggested as a basis for reimbursement under Medicare’s ‘‘Value-Based Purchasing’’
program. Our analyses showed that hospital performance is substantially associated with local economic and workforce
resources. For example, for HF in 2004, hospitals located in counties with longstanding poverty had mean HQA composite
scores of 73.0, compared with a mean of 84.1 for hospitals in counties without longstanding poverty (p,0.001). Hospitals
located in counties in the lowest quartile with respect to college graduates in the workforce had mean HQA composite
scores of 76.7, compared with a mean of 86.2 for hospitals in the highest quartile (p,0.001). Performance on AMI measures
showed similar patterns. Performance improved generally over the study period. Nevertheless, by 2007—4 years after public
reporting began—hospitals in locationally disadvantaged areas still lagged behind their locationally advantaged
counterparts. This lag translated into substantially lower net scores under the Performance Assessment Model for hospital
reimbursement.
Conclusions: Hospital performance on clinical process measures is associated with the quantity and quality of local
economic and human resources. Medicare’s hospital pay-for-performance program may exacerbate inequalities across
regions, if implemented as currently proposed. Policymakers in the US and beyond may need to take into consideration the
balance between greater efficiency through pay-for-performance and socioeconomic equity.
Published Version: doi:10.1371/journal.pmed.1000297
Other Sources: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2893955/pdf/
Terms of Use: This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA
Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:11213325
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