OBJECTIVES: The CMS core conditions-acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia-are a focus of hospital quality reporting and its value-based purchasing program. The study's purpose was to assess national trends of in-hospital mortality and resource utilization for these core measures. STUDY DESIGN: A time series study using outcomes from the 5 yearly cycles of the Nationwide Inpatient Sample (2005-2009). METHODS: Stratum-specific χ2 test for independence (binary or categorical parameters) or t test for a contrasted mean (continuous parameters) were used to identify parameters that changed significantly over time (in-hospital mortality, length of stay, cost, charges, severity of illness, diagnoses per case, procedures per case). Multiple logistic and linear regression models were used to identify factors associated with in-hospital deaths, hospital charges, and length of stay (LOS). RESULTS: In-hospital mortality decreased for AMI, CHF, and pneumonia. LOS was unchanged for CHF, but decreased for AMI and pneumonia. Average inflation-adjusted charges per case increased for all 3 conditions, while the average inflation-adjusted cost per case decreased for CHF and remained stable for AMI and pneumonia. The proportion of patients with extreme disability and extreme likelihood of dying, as defined by All-Patient-Refined Diagnosis Related Group, increased for all 3 diagnoses. The number of diagnoses and procedures were independently associated with LOS, cost, and charges for all 3 conditions. CONCLUSIONS: Many measures of quality of inpatient care and resource utilization for CMS core conditions improved despite increases in patient complexity and risk of mortality. Further research is necessary to determine the exact causes of these improvements.
OBJECTIVES: The CMS core conditions-acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia-are a focus of hospital quality reporting and its value-based purchasing program. The study's purpose was to assess national trends of in-hospital mortality and resource utilization for these core measures. STUDY DESIGN: A time series study using outcomes from the 5 yearly cycles of the Nationwide Inpatient Sample (2005-2009). METHODS: Stratum-specific χ2 test for independence (binary or categorical parameters) or t test for a contrasted mean (continuous parameters) were used to identify parameters that changed significantly over time (in-hospital mortality, length of stay, cost, charges, severity of illness, diagnoses per case, procedures per case). Multiple logistic and linear regression models were used to identify factors associated with in-hospital deaths, hospital charges, and length of stay (LOS). RESULTS: In-hospital mortality decreased for AMI, CHF, and pneumonia. LOS was unchanged for CHF, but decreased for AMI and pneumonia. Average inflation-adjusted charges per case increased for all 3 conditions, while the average inflation-adjusted cost per case decreased for CHF and remained stable for AMI and pneumonia. The proportion of patients with extreme disability and extreme likelihood of dying, as defined by All-Patient-Refined Diagnosis Related Group, increased for all 3 diagnoses. The number of diagnoses and procedures were independently associated with LOS, cost, and charges for all 3 conditions. CONCLUSIONS: Many measures of quality of inpatient care and resource utilization for CMS core conditions improved despite increases in patient complexity and risk of mortality. Further research is necessary to determine the exact causes of these improvements.