Table 3.
Regression Results of ALCR on HVBP Sub-Domains (Clinical, Safety, Engagement & Efficiency)
| Analysis of Association Between ALCR and Quality | Clinical Outcomes Domain Score | Safety Domain Score | Engagement Domain Score | Efficiency Domain Score | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| N = 2295, Adj R2 = 11.0% | N = 1878, Adj R2 = 18.5% | N = 2304, Adj R2 = 37.2% | N = 2307, Adj R2 = 35.1% | |||||||||
| β | S.E. | Sig | β | S.E. | Sig | β | S.E. | Sig | β | S.E. | Sig | |
| ALCR | −4.129 | 1.326 | ** | −1.522 | 1.58 | – | −10.498 | 1.276 | *** | −4.932 | 1.811 | ** |
| Number of discharges (in thousands) | 0.043 | 0.018 | ** | −0.052 | 0.021 | ** | 0.006 | 0.017 | – | 0.004 | 0.024 | – |
| Number of staffed beds (in thousands) | 0.164 | 1.064 | – | −3.766 | 1.267 | *** | −4.153 | 1.024 | *** | −6.971 | 1.453 | *** |
| Location (Rural) | −0.381 | 0.315 | – | 1.092 | 0.376 | ** | 2.135 | 0.303 | *** | 2.221 | 0.431 | *** |
| Average age of facility (Years) | −0.003 | 0.009 | – | 0.016 | 0.011 | – | 0.009 | 0.009 | – | 0.028 | 0.013 | * |
| Bed utilization rate | −0.003 | 0.006 | – | −0.011 | 0.007 | – | −0.045 | 0.006 | *** | −0.038 | 0.008 | *** |
| Average Length of Stay | 0.097 | 0.035 | ** | −0.407 | 0.042 | *** | −0.595 | 0.034 | *** | −0.773 | 0.048 | *** |
| Academic medical center | 0.942 | 0.458 | * | −0.075 | 0.546 | – | 2.333 | 0.441 | *** | 1.696 | 0.626 | ** |
| Sole community hospital | 0.442 | 0.338 | – | 0.412 | 0.403 | – | −0.399 | 0.325 | – | 1.121 | 0.462 | * |
| Competition (HHI) | −2.545 | 0.405 | *** | −1.073 | 0.483 | * | −0.153 | 0.39 | – | 0.695 | 0.554 | – |
| Government operated | −0.752 | 0.296 | ** | −0.791 | 0.353 | * | −0.312 | 0.285 | – | −2.041 | 0.404 | *** |
| For profit | 0.241 | 0.265 | – | 1.097 | 0.316 | *** | −2.788 | 0.255 | *** | −1.765 | 0.362 | *** |
| Payor mix: Medicaid days | 0.035 | 0.009 | *** | 0.004 | 0.011 | – | 0.026 | 0.009 | ** | −0.069 | 0.013 | *** |
| Payor mix: Medicare days | −0.029 | 0.011 | ** | 0.015 | 0.014 | – | 0.016 | 0.011 | – | 0.024 | 0.016 | – |
| Case mix index (CMI) | 1.128 | 0.364 | ** | −3.478 | 0.433 | *** | −2.301 | 0.35 | *** | −4.045 | 0.497 | *** |
| Surgical CMI | −1.768 | 0.959 | + | 2.655 | 1.143 | * | −7.72 | 0.923 | *** | −12.782 | 1.31 | *** |
| Medical CMI | −0.552 | 0.289 | * | 1.679 | 0.345 | *** | 1.609 | 0.278 | *** | 1.720 | 0.395 | *** |
| CC/mcc rate | 3.416 | 1.005 | *** | −2.875 | 1.198 | * | −0.492 | 0.967 | – | 7.909 | 1.373 | *** |
| Region2 (NJ, NY, PA) | −1.562 | 0.539 | ** | 0.703 | 0.643 | – | −1.357 | 0.519 | ** | 0.761 | 0.737 | – |
| Region3 (DE, KY, MD, NC, VA, WV, DC) | −2.314 | 0.569 | *** | 1.164 | 0.678 | + | −0.068 | 0.547 | – | 1.663 | 0.777 | * |
| Region4 (AL, FL, GA, MS, SC, TN, PR) | −2.608 | 0.524 | *** | 1.055 | 0.624 | + | 0.518 | 0.504 | – | −0.192 | 0.716 | – |
| Region5 (IL, MI, IN, OH, WI) | −0.842 | 0.526 | – | 0.102 | 0.626 | – | −0.35 | 0.506 | – | −0.485 | 0.718 | – |
| Region6 (IA, KS, MN, MO, NE, ND, SD) | −1.452 | 0.564 | ** | 0.322 | 0.672 | – | 0.158 | 0.543 | – | 3.557 | 0.771 | *** |
| Region7 (AR, LA, OK, TX) | −2.078 | 0.543 | *** | 1.379 | 0.647 | * | 0.791 | 0.523 | – | −1.778 | 0.742 | * |
| Region8 (AZ, CO, ID, MT, NM, UT, WY) | −1.211 | 0.594 | * | 0.819 | 0.708 | – | 0.371 | 0.571 | – | 2.160 | 0.811 | ** |
| Region9 (AK, CA, HI, NV, OR, WA) | −0.800 | 0.541 | – | 1.689 | 0.645 | ** | −0.381 | 0.521 | – | 3.892 | 0.739 | *** |
Notes: + p < 0.1, * p < 0.05; ** p < 0.01; *** p < 0.001; Region 1 (CT, ME, MA, NH, RI, VT) is referent.
Abbreviations: ALCR, Agency labor cost ratio; HBVP, Hospital value-based purchasing; HHI, Hirschman-Herfindahl Index; CMI, Case mix index; CC/MCC, Complication/comorbidity and major complication/comorbidity.