Hospitals in United States Dependencies Deficient

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Study: Hospitals in PR, territories lag

By : Kevin Mead 
Caribbean Business

kevin@caribbeanbusinesspr.com

Many U.S. citizens who call the U.S. territories home are at a major healthcare disadvantage compared to their counterparts in the 50 states, a new study by Yale School of Medicine researchers shows.

Certain groups of patients treated at hospitals in U.S. territories have poorer outcomes and higher death rates than those treated at hospitals in U.S. states, according to the study published in the Archives of Internal Medicine.

Led by Dr. Marcella Nuñez-Smith, assistant professor at Yale School of Medicine, researchers examined data on 57 territorial hospitals and 4,799 stateside hospitals that discharged at least one Medicare fee-for-service adult patient with heart attack, heart failure or pneumonia who were treated between July 2005 and June 2008.

The territorial hospitals had worse performance in treating all three conditions and had higher death rates. Compared to stateside hospitals, territorial hospitals had about two additional deaths for every 100 heart attack patients, one additional death for every 100 heart failure patients, and three additional deaths for every 100 pneumonia patients.

Hospitals in Puerto Rico performed similarly to other territories on most core processes measured.

Among the findings, there is a 17 percent greater risk of dying after a heart attack if you are treated in a hospital located in a U.S. territory— such as Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa and Northern Mariana Islands — rather than in a hospital in the mainland United States.

The authors used data from Medicare to study all patients suffering from a heart attack who were admitted to 57 hospitals in the U.S. territories. They compared these to heart attack patients admitted to 4,799 hospitals in the mainland between July 2005 and June 2008. They found that the risk of death within 30 days after a heart attack was substantially higher for patients in all of the U.S. territories.

“We were shocked by these findings,” said Nuñez-Smith. “These are serious and substantial differences and translate into increased lives lost in the U.S. territories.”

Nuñez-Smith and her colleagues sought explanations for these findings by exploring whether patients overall just got sicker in the U.S. territories, but found that was not the case.

“Studies about hospital quality of care in the U.S. typically exclude hospitals in the U.S. territories or combine them with other U.S. regional areas, masking potential differences between quality of care between the territories and states,” she said.

“This work does put the spotlight on the need for increased resources in the U.S. territories to improve the quality of care,” said Nuñez-Smith. Despite the national effort to address health care disparities through increased public reporting and standardizing hospital performance, hospitals in the U.S. territories have been largely neglected.”

One potential policy area for follow-up would be Medicare reimbursement rates. Hospitals in the U.S. territories have the lowest reimbursement rates of anywhere in the nation.

“We plan to do follow-up work with hospitals in the U.S. territories and policymakers to identify opportunities to improve health outcomes for people who live, work and play in the U.S territories,” Nuñez-Smith said.