Table 3.
Characteristics of Acute Care Hospitals* from Which Fee-for-Service Medicare Patients with COPD Were Discharged from December 2006 to November 2017 in the United States
| HRRP Periods | Preannouncement |
Announcement |
Implementation |
P Value† | |||
|---|---|---|---|---|---|---|---|
| December 2006 to July 2008 | August 2008 to March 2010 | April 2010 to November 2011 | January 2013 to August 2014 | October 2014 to April 2016 | May 2016 to November 2017 | ||
| Unique hospitals | 3,457 (100) | 3,392 (100) | 3,332 (100) | 3,296 (100) | 3,244 (100) | 3,172 (100) | — |
| Teaching hospital‡ | <0.0001 | ||||||
| Major/graduate | 601 (17.3) | 580 (17.1) | 575 (17.26) | 562 (17.05) | 562 (17.32) | 555 (17.5) | |
| Limited | 450 (13.02) | 471 (13.89) | 467 (14.02) | 501 (15.2) | 523 (16.1) | 541 (17.06) | |
| No affiliation | 2,376 (68.7) | 2,327 (68.6) | 2,289 (68.7) | 2,212 (67.1) | 2,129 (65.6) | 2,074 (65.3) | |
| Unknown | 30 (0.8) | 14 (0.4) | 1 (0.03) | 21 (0.6) | 30 (0.9) | 2 (0.06) | |
| Transplant Center | <0.0001 | ||||||
| Yes | 760 (21.9) | 748 (22.05) | 670 (20.1) | 584 (17.7) | 535 (16.4) | 528 (16.6) | |
| No | 2,667 (77.1) | 2,630 (77.5) | 2,661 (79.8) | 2,691 (81.6) | 2,679 (82.5) | 2,642 (83.2) | |
| Unknown | 30 (0.8) | 14 (0.4) | 1 (0.03) | 21 (0.6) | 30 (0.9) | 2 (0.06) | |
| Bed count | 0.0117 | ||||||
| <100 | 1,065 (30.8) | 1,057 (31.1) | 1,026 (30.7) | 988 (29.9) | 939 (28.9) | 908 (28.6) | |
| 100–250 | 1,218 (35.2) | 1,203 (35.4) | 1,183 (35.5) | 1,171 (35.5) | 1,167 (35.9) | 1,151 (36.2) | |
| 250–500 | 807 (23.3) | 780 (23) | 781 (23.4) | 771 (23.3) | 760 (23.4) | 761 (23.9) | |
| >500 | 337 (9.7) | 338 (9.9) | 341 (10.2) | 345 (10.4) | 348 (10.7) | 350 (11.03) | |
| Unknown | 30 (0.8) | 14 (0.4) | 1 (0.03) | 21 (0.6) | 30 (0.9) | 2 (0.06) | |
| Metro§ | <0.0001 | ||||||
| Metro | 2,427 (70.2) | 2,397 (70.6) | 2,369 (71.1) | 2,343 (71.0) | 2,310 (71.2) | 2,366 (74.5) | |
| Nonmetro | 921 (26.6) | 909 (26.8) | 886 (26.5) | 857 (26) | 830 (25.5) | 796 (25.09) | |
| Unknown | 109 (3.1) | 86 (2.5) | 77 (2.3) | 96 (2.9) | 104 (3.2) | 10 (0.3) | |
| Region | 0.5929 | ||||||
| Midwest | 754 (21.8) | 750 (22.1) | 745 (22.3) | 730 (22.1) | 723 (22.2) | 709 (22.3) | |
| Northeast | 544 (15.7) | 529 (15.6) | 511 (15.3) | 502 (15.2) | 489 (15.07) | 479 (15.1) | |
| South | 1,420 (41.0) | 1,408 (41.5) | 1,393 (41.8) | 1,367 (41.4) | 1,337 (41.2) | 1,319 (41.5) | |
| West | 654 (18.9) | 641 (18.9) | 630 (18.9) | 624 (18.9) | 612 (18.8) | 609 (19.2) | |
| Unknown | 85 (2.4) | 64 (1.8) | 53 (1.5) | 73 (2.2) | 83 (2.5) | 56 (1.7) | |
| Ownership|| | <0.0001 | ||||||
| Profit | 646 (18.6) | 629 (18.5) | 650 (19.5) | 671 (20.3) | 667 (20.5) | 669 (21.09) | |
| Nonprofit | 2,112 (61.0) | 2,089 (61.5) | 2,049 (61.4) | 2,009 (60.9) | 1,988 (61.2) | 1,988 (62.6) | |
| Government | 669 (19.3) | 660 (19.4) | 632 (18.9) | 595 (18.0) | 559 (17.2) | 513 (16.1) | |
| Unknown | 30 (0.87) | 14 (0.41) | 1 (0.03) | 21 (0.64) | 30 (0.92) | 2 (0.06) | |
| Full-time nurses per bed | <0.0001 | ||||||
| ≤1 | 1,944 (56.2) | 1,799 (53.0) | 1,678 (50.3) | 1,510 (45.8) | 1,407 (43.37) | 1,321 (41.6) | |
| >1 | 1,483 (42.9) | 1,579 (46.5) | 1,653 (49.6) | 1,765 (53.5) | 1,807 (55.7) | 1,849 (58.2) | |
| Unknown | 30 (0.8) | 14 (0.4) | 1 (0.03) | 21 (0.6) | 30 (0.9) | 2 (0.06) | |
| % of patients who gave high rating¶ | <0.0001 | ||||||
| <70% | 1,832 (52.9) | 2,473 (72.9) | 2,058 (61.7) | 1,656 (50.2) | 1,498 (46.1) | 1,231 (38.8) | |
| ≥70% | 450 (13.02) | 723 (21.3) | 1,121 (33.6) | 1,488 (45.1) | 1,592 (49.08) | 1,793 (56.5) | |
| Unknown | 1,175 (33.9) | 196 (5.7) | 153 (4.5) | 152 (4.6) | 154 (4.7) | 148 (4.6) | |
Definition of abbreviations: COPD = chronic obstructive pulmonary disease; HCAHPS = Hospital Consumer Assessment of Healthcare Providers and Systems; HRRP = Hospital Readmissions Reduction Program.
Data are expressed as n (%).
Hospital characteristics (except for patient rating) were collected from Centers for Medicare and Medicaid Services Provider of Service files 2007, 2009, 2011, 2013, 2015, and 2017 for the three periods.
Generalized estimating equation models were used to determine significance of trend over time for each characteristic.
Medical school affiliation involvement follows graduate > major > limited > no affiliation from most extensive to least. We grouped graduate and major in one category.
Hospital metro indicator was determined by county codes by the United States Department of Agriculture, Economic Research Service 2013 metro and nonmetro categories.
Hospital ownership categories defined in Table E3.
Patient ratings were collected from HCAHPS patient experience survey (36). We used HCAHPS: Patients’ Perspectives of Care Survey years 2008, 2009, 2011, 2013, 2015, and 2017 since the first public reporting of HCAHPS results occurred in March 2008.