Table 1.
Patient and hospital characteristics by hospital performance quintile in risk and reliability-adjusted cirrhosis mortality
| Q1 (highest performance) | Q2 | Q3 | Q4 | Q5 (lowest performance) | Overall | P value | |
| Patient characteristics | |||||||
| Patients | 21524 | 11117 | 12427 | 12648 | 15017 | 72733 | - |
| Demographics | |||||||
| Age | |||||||
| Mean age (yr) | 56.8 | 57.5 | 57.6 | 57.3 | 57.4 | 57.2 | < 0.00001 |
| Sex | |||||||
| Female (%) | 36.4 | 36.7 | 35.9 | 35.0 | 35.3 | 35.9 | 0.01381 |
| Race | |||||||
| White (%) | 59.9 | 55.6 | 54.8 | 51.7 | 52.6 | 55.4 | < 0.00001 |
| Black (%) | 5.8 | 7.7 | 5.6 | 5.7 | 9.0 | 6.7 | |
| Hispanic (%) | 15.2 | 20.2 | 21.5 | 17.4 | 20.3 | 18.5 | |
| Asian or Pacific Islander (%) | 1.6 | 1.8 | 2.3 | 1.3 | 2.2 | 1.8 | |
| Native American (%) | 1.6 | 0.5 | 0.8 | 1.1 | 0.9 | 1.1 | |
| Other (%) | 1.6 | 2.0 | 2.6 | 3.3 | 3.1 | 2.4 | |
| Missing (%) | 14.4 | 12.1 | 12.4 | 19.6 | 12.0 | 14.1 | |
| Insurance | |||||||
| Medicare (%) | 36.1 | 37.2 | 38.0 | 36.9 | 37.3 | 37.0 | < 0.00001 |
| Medicaid (%) | 22.9 | 24.5 | 24.8 | 23.8 | 26.5 | 24.4 | |
| Private Insurance (%) | 27.4 | 26.5 | 25.2 | 25.3 | 22.5 | 25.5 | |
| Self-Pay (%) | 7.5 | 7.4 | 7.3 | 8.4 | 7.8 | 7.7 | |
| No Charge (%) | 1.0 | 0.4 | 0.6 | 0.5 | 1.5 | 0.9 | |
| Other (%) | 5.0 | 4.0 | 4.0 | 5.0 | 4.3 | 4.6 | |
| Cause of cirrhosis1 | |||||||
| Alcoholic liver disease (%) | 61.0 | 62.5 | 61.0 | 60.8 | 60.3 | 61.1 | 0.00880 |
| Alcoholic cirrhosis (%) | 60.9 | 62.4 | 60.9 | 60.6 | 60.2 | 60.9 | 0.00589 |
| Non-alcoholic cirrhosis (%) | 38.0 | 36.9 | 38.0 | 38.6 | 39.0 | 38.1 | 0.00762 |
| Biliary cirrhosis (%) | 2.3 | 1.5 | 2.0 | 1.7 | 1.6 | 1.9 | < 0.00001 |
| HCV positive (%) | 25.3 | 23.0 | 22.1 | 25.1 | 26.4 | 24.6 | < 0.00001 |
| Unspecified liver disease or cirrhosis (%) | 2.7 | 2.0 | 2.0 | 2.0 | 1.8 | 2.2 | < 0.00001 |
| A1AT, Cu, Fe disease (%) | 0.89 | 0.65 | 0.64 | 0.74 | 0.68 | 0.74 | 0.04067 |
| Complications of Cirrhosis | |||||||
| Ascites (%) | 31.8 | 27.5 | 30.2 | 30.3 | 26.9 | 29.6 | < 0.00001 |
| Variceal bleed (%) | 9.6 | 10.3 | 9.6 | 9.3 | 9.4 | 9.6 | 0.05605 |
| Hepatic Encephalopathy (%) | 53.7 | 55.2 | 52.5 | 54.1 | 55.7 | 54.2 | < 0.00001 |
| Portal HTN (%) | 44.3 | 41.1 | 44.9 | 42.7 | 41.5 | 43.0 | < 0.00001 |
| Hepatorenal syndrome (%) | 9.3 | 7.8 | 8.2 | 8.3 | 8.9 | 8.6 | 0.00003 |
| Hepatocellular carcinoma (%) | 3.9 | 2.7 | 3.1 | 3.1 | 3.2 | 3.3 | < 0.00001 |
| Procedures | |||||||
| Liver transplant | 2.7 | 0.6 | 1.0 | 1.1 | 2.4 | 1.7 | < 0.00001 |
| Esophagogastroduodenoscopy | 18.1 | 19.0 | 20.4 | 19.3 | 18.3 | 18.9 | < 0.00001 |
| Paracentesis | 32.9 | 29.7 | 30.0 | 29.7 | 29.2 | 30.6 | < 0.00001 |
| Mortality characteristics | |||||||
| APR-DRG Risk of Mortality | |||||||
| Minor risk of mortality (%) | 5.9 | 7.8 | 6.8 | 6.5 | 9.1 | 7.1 | < 0.00001 |
| Moderate risk of mortality (%) | 31.3 | 34.1 | 34.4 | 33.2 | 34.0 | 33.2 | |
| Major risk of mortality (%) | 41.0 | 39.4 | 39.4 | 39.5 | 37.0 | 39.4 | |
| Extreme risk of mortality (%) | 21.8 | 18.7 | 19.4 | 20.7 | 19.9 | 20.3 | |
| Mortality | |||||||
| Expired during admission (%) | 5.1 | 6.0 | 7.5 | 9.8 | 12.3 | 7.9 | < 0.00001 |
| Hospital characteristic | |||||||
| Number of hospitals | 161 | 161 | 161 | 161 | 161 | 805 | - |
| Region | |||||||
| Northeast hospital region (%) | 19.3 | 25.5 | 27.3 | 24.8 | 34.2 | 26.2 | 0.06961 |
| Midwest hospital region (%) | 18.6 | 13.7 | 17.4 | 13.0 | 9.3 | 14.4 | |
| South hospital region (%) | 29.2 | 32.3 | 19.9 | 29.2 | 26.7 | 27.5 | |
| West hospital region (%) | 32.9 | 28.6 | 35.4 | 32.9 | 29.8 | 31.9 | |
| Bed capacity | |||||||
| Small bedsize (%) | 23.0 | 41.0 | 36.6 | 33.5 | 32.3 | 33.3 | 0.05554 |
| Medium bedsize (%) | 37.9 | 31.7 | 32.9 | 34.2 | 29.8 | 33.3 | |
| Large bedsize (%) | 39.1 | 27.3 | 30.4 | 32.3 | 37.9 | 33.4 | |
| Hospital ICU beds (mean) | 24.3 | 19.1 | 20.1 | 19.9 | 20.8 | 20.8 | 0.04608 |
| Patient casemix | |||||||
| Hospital Cirrhosis Annual Volume (mean) | 133.7 | 69.0 | 77.2 | 78.6 | 93.3 | 90.4 | < 0.00001 |
| Medicaid Days (mean) | 18139 | 15339 | 18158 | 18699 | 22662 | 18599 | 0.18260 |
| Admission characteristics | |||||||
| Length of stay (days) (mean) | 5.9 | 5.7 | 5.9 | 6.2 | 6.4 | 6.0 | 0.00019 |
| Total charges ($ mean)2 | 43391 | 36593 | 40500 | 43389 | 40340 | 40877 | 0.19458 |
| Expired during admission (%) | 4.0 | 5.3 | 7.3 | 10.1 | 13.2 | 8.0 | < 0.00001 |
| Staffing characteristics | |||||||
| Full-time LPN’s3 (mean) | 1.65 | 2.18 | 2.18 | 1.94 | 2.34 | 2.06 | 0.03218 |
| Full-time MD’s3 (mean) | 2.74 | 2.02 | 2.55 | 1.88 | 1.8 | 2.2 | 0.27122 |
| Teaching Status | |||||||
| Teaching hospital4 (%) | 42.9 | 32.9 | 38.5 | 39.8 | 41.6 | 39.1 | 0.40386 |
| Resident FTE’s (mean) | 79.2 | 40.7 | 57.7 | 59.0 | 65.7 | 60.5 | 0.33158 |
| Specialty Services | |||||||
| Liver transplant hospital (%) | 15.5 | 5.0 | 5.0 | 5.6 | 4.3 | 7.1 | 0.00020 |
1
Patients have multiple diagnoses;
2
19 hospitals missing total charge data on 1751 patients;
3
per 10000 Adjusted Patient days;
4
43 hospitals that changed teaching status during the study period were considered teaching if 50% or more of patients were admitted while a teaching hospital.