Hospital quality may trump patient socioeconomic status in predicting survival

A research study aimed at uncovering why poorer patients tend to have worse treatment outcomes finds that the quality of the hospitals serving poor communities may be a bigger factor than socioeconomic status in determining mortality risk after cancer surgery.

The study, which was published in JAMA Surgery, has implications for healthcare reform efforts to tie hospital payments to quality measures. Since multiple research studies have shown that patients that have low socioeconomic status tend to have poorer outcomes, hospitals that primarily treat dual eligibles (patients that qualify for both Medicare and Medicaid benefits because of poverty) argue that they are unfairly penalized by reimbursement models that link payments to outcomes. There is even a bill currently before Congress that seeks to reduce readmission penalties on hospitals that treat primarily dual eligibles. (Read more here.)

However, this study’s findings punch a big hole in the argument that hospitals that treat more poor patients are essentially equal in quality to other hospitals and that their lower scores on outcome measures are just due to their patients’ socioeconomic status.

Senior study author Amir Ghaferi, M.D., M.S., and his colleagues at the Center for Healthcare Outcomes and Policy at the University of Michigan in Ann Arbor looked at Medicare data on patients who had surgery to treat cancer and found that patients with higher socioeconomic status that were treated at hospitals serving primarily low socioeconomic status communities had worse outcomes than patients with lower socioeconomic status that were treated at hospitals serving primarily high socioeconomic status communities. Outcome measures included operative mortality, postoperative complications and failure to rescue or FTR, a measure of case fatality after one or more major postoperative complications.

The authors concluded that future research should look more closely at the hospital processes and characteristics that might be the reason the cancer patients treated at the institutions serving primarily low socioeconomic status communities were more likely to die if they developed a complication after surgery. Relatively simple factors such as the attitude of physicians and staff toward patient safety could be behind the findings the researchers observed, noted Ghaferi in an interview with Reuters Health about the study.