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Quality of Care in Hospitals with a High Percent of Medicaid Patients

Goldman, L Elizabeth MD, MCR*; Vittinghoff, Eric PhD; Dudley, R Adams MD, MBA*‡

doi: 10.1097/MLR.0b013e318041f723
Brief Report

Background: Certain hospitals play a central role in ensuring Medicaid-insured patients' access to care. Their quality of care is critical to evaluate.

Objective: To determine whether hospitals for which Medicaid patients represent a high percentage of total discharges provide a different quality of care than other hospitals.

Research Design: Cross-sectional analysis.

Subjects: Acute care hospitals participating in the first Hospital Compare public report (released November 2004) and the 2004 American Hospital Association hospital survey.

Measures: Hospitals serving 1 standard deviation above the national mean percentage of Medicaid patients were designated high Medicaid hospitals. Performance was assessed using percent compliance with 10 processes of care for 3 conditions: myocardial infarction, congestive heart failure, and community-acquired pneumonia.

Results: Among the 2874 nonteaching hospitals, high Medicaid hospitals had lower adherence (P < 0.01) than other nonteaching hospitals on all 10 indicators. Of particular clinical importance, high Medicaid nonteaching hospitals less frequently prescribed β-blockers (83% vs. 90%%, P < 0.0001) and aspirin at discharge in myocardial infarction (85% vs. 91%%, P < 0.0001), and administered antibiotics on time in CAP (68% vs. 75%, P < 0.0001). Among teaching institutions, there were few differences between high Medicaid and other hospitals.

Conclusions: Among hospitals publicly reporting on the Hospital Compare Web site, nonteaching hospitals treating a high percentage of Medicaid patients had lower adherence to quality indicators than other nonteaching hospitals on 10 indicators. Further research is needed to determine what factors contribute to differences in reported quality.

From the Departments of *Medicine and †Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California; and ‡Institute of Health Policy, University of California, San Francisco, San Francisco, California.

Supported by the Agency for Healthcare Research and Quality, an Investigator Award from the Robert Wood Johnson Foundation, and the California Program on Access to Care.

Reprints: L. Elizabeth Goldman, MD, MCR, University of California, San Francisco, 533 Parnassus Avenue, Box 0131, San Francisco, CA 94110. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.