Healthcare Safety-Net in the United States: Patient Satisfaction across Rural and Urban Hospitals

Objective. To examine rurality and other hospital characteristics associated with patient satisfaction across hospitals in the United States. Data. Nationwide hospital data from the 2019 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and the 2020 Centers for Medicare & Medicaid Services (CMS) Provider of Services (POS) file. Study Design. Hospital ZIP-codes were categorized into urban, rural micropolitan, or small/isolated rural based on Rural-Urban Commuting Area (RUCA) codes. Patient satisfaction measures from the HCAHPS survey were linked to the CMS POS data for hospital characteristics, yielding 2,357 urban, 749 rural micropolitan, and 1,343 small/isolated rural hospitals. ANOVA and chi-square tests were conducted to compare patient satisfaction measures and hospital characteristics by rurality. Generalized linear models were employed to examine marginal differences of hospital rurality on patient satisfaction, controlling for other hospital characteristics. Principal Findings. While small/isolated rural hospitals were less likely to be accredited, to have medical school affiliation, and to have high staffing, they were more likely to have pharmacy services collocated within a hospital, patients insured by Medicare and Medicaid, and critical access hospital (CAH) designations. Small/isolated rural hospitals had the highest average survey response rates at 3.26 percentage points above the national average. In particular, compared to urban hospitals, small/isolated rural hospitals had higher percentages of patients reporting that nurses or doctors always communicated well (average marginal effects: 1.63; 95% CI, 1.14-2.12 (nurses) and 2.61 [2.12-3.10] (doctors)), that they always received help as soon as they wanted (4.36 [3.56-5.16]), and that staff always explained possible side effects (3.28 [2.50-4.06]). Conclusions. Safety-net, or small/isolated rural, hospitals reported higher patient satisfaction compared to non-safety-net hospitals. Many of these safety-net hospitals were designated as CAH, relied more on Medicare and Medicaid insurance, and offered on-site pharmaceutical services. These findings signal the important role that safety-net hospitals play in providing satisfactory healthcare to underserved communities

Paley-Wiener Theorem for Line Bundles over Compact Symmetric Spaces

We generalize a Paley-Wiener theorem to homogeneous line bundles $L_\chi$ on a compact symmetric space U/K with $\chi$ a nontrivial character of K. The Fourier coefficients of a $\chi$-bi-coinvariant function f on U are defined by integration of f against the elementary spherical functions of type $\chi$ on U, depending on a spectral parameter $\mu$, which in turn parametrizes the $\chi$-spherical representations $\pi$ of U. The Paley-Wiener theorem characterizes f with sufficiently small support in terms of holomorphic extendability and exponential growth of their $\chi$-spherical Fourier transforms. We generalize Opdam\u27s estimate for the hypergeometric functions in a bigger domain with the multiplicity parameters being not necessarily positive, which is crucial to the proof of Paley-Wiener theorem in our case

Data-Driven Abstraction

Given a program analysis problem that consists of a program and a property of interest, we use a data-driven approach to automatically construct a sequence of abstractions that approach an ideal abstraction suitable for solving that problem. This process begins with an infinite concrete domain that maps to a finite abstract domain defined by statistical procedures resulting in a clustering mixture model. Given a set of properties expressed as formulas in a restricted and bounded variant of CTL, we can test the success of the abstraction with respect to a predefined performance level. In addition, we can perform iterative abstraction-refinement of the clustering by tuning hyperparameters that determine the accuracy of the cluster representations (abstract states) and determine the number of clusters. Our methodology yields an induced abstraction and refinement procedure for property verification

Estimating cost savings from regionalizing cardiac procedures using hospital discharge data

<p>Abstract</p> <p>Background</p> <p>We examined whether higher procedure volumes for coronary artery bypass graft (CABG) surgery or percutaneous coronary interventions (PCI) were associated with lower costs per patient, and if so, estimated the financial savings from regionalizing cardiac procedures.</p> <p>Methods</p> <p>Cost regressions with hospital-specific dummy variables measured within-hospital cost reductions associated with increasing hospital volume. We used the regression estimates to predict the change in total costs that would result from moving patients in low-volume hospitals to higher volume facilities.</p> <p>Results</p> <p>A 10% increase in PCI procedure volume lowered costs per patient by 0.7%. For the average hospital performing CABG in 2000, a 10% increase in volume was associated with a 2.8% reduction in average costs. Despite these lower costs, the predicted savings from regionalizing all PCI procedures in the sample from lower to high-volume hospitals amounted to only 1.1% of the entire costs of performing PCI procedures for the sample in 2000. Similarly, the cost savings for CABG were estimated to be only 3.5%.</p> <p>Conclusion</p> <p>Higher volumes were associated with lower costs per procedure. However, the total potential savings from regionalizing cardiac procedures is relatively minor, and may not justify the risks of reducing access to needed services.</p

Will the currently proposed reforms to the Affordable Care Act raise the proportion of Texans without health insurance coverage?

Will the currently proposed reforms to the Affordable Care Act raise the proportion of Texans without health insurance coverage? In this issue of the Health Policy Newsletter, the authors analyze the potential impact of proposed legislation to repeal and replace the ACA

Regionalization Versus Competition in Complex Cancer Surgery

The empirical association between high hospital procedure volume and lower mortality rates has led to recommendations for the regionalization of complex surgical procedures. While regionalization may improve outcomes, it also reduces market competition, which has been found to lower prices and improve health care quality. This study estimates the potential net benefits of regionalizing the Whipple surgery for pancreatic cancer patients. We confirm that increased hospital volume and surgeon volume are associated with lower inpatient mortality rates. We then predict the price and outcome consequences of concentrating Whipple surgery at hospitals that perform at least two, four, and six procedures respectively per year. Our consumer surplus calculations suggest that regionalization can increase consumer surplus, but potential price increases extract over half of the value of reduced deaths from regionalization. We reach three conclusions. First, regionalization can increase consumer surplus, but the benefits may be substantially less than implied by examining only the outcome side of the equation. Second, modest changes in outcomes due to regionalization may lead to decreases in consumer surplus. Third, before any regionalization policy is implemented, a deep and precise understanding of the nature of both outcome/volume and price/competition relationships is needed

Possible Role of Descemet-Stroma Interface for Descemet's Membrane Detachment after Penetrating Keratoplasty.

PurposeTo report two cases of spontaneous Descemet's membrane detachment (DMD) and dehiscence following penetrating keratoplasty (PK).Case reportsSpontaneous DMD or Descemet's membrane (DM) dehiscence following PK is a rare occurrence. Here, we describe two cases of such an occurrence following PK arising from the graft-host interface. A possible causative relation between DMD/dehiscence and DM-stromal interface attachment is suggested.ConclusionDMD and dehiscence after PK can be explained by the peripheral thinning of DM and possible changes to the recently characterized anchoring zone of interwoven collagen fibers and proteoglycans at the Descemet-stroma interface