Hospital patients’ risk of death has fallen substantially since the COVID-19 pandemic and the months preceding it, even as hospitals are treating more and sicker patients, according to a new report on 715 acute care centers’ performance data.
The analysis, conducted by Vizient and released by the American Hospital Association (AHA), reviewed changes in patient safety metrics from the fourth quarter of 2019 through the first quarter of 2024.
Across that period, inpatient discharges dropped as much as 20% during the pandemic’s onset and then ping-ponged until steadily increasing upon the start of 2023. By the end of this year’s first quarter, discharges were up 1.6% from 2019’s baseline.
Case mix index, which measures the severity and complexity of a patient’s condition, has remained above the analysis’ start date. Though lower in early 2024 than during the pandemic’s winter waves, patient acuity was still about 3% higher than in late 2019.
Against that backdrop, the AHA’s report celebrated “better than expected” risk-adjusted mortality seen across Vizient’s data set since 2022. Compared to the fourth-quarter 2019 baseline, the difference between model-predicted mortality and actual mortality was about 22% lower by the end of the study period.
Further, combining Vizient’s risk-adjusted mortality numbers with the hospital lobby’s national hospitalization data suggests that an estimated 200,000 Americans hospitalized between April 2023 and March 2024 survived a stay they would not have in late 2019, according to the report.
Rather than attribute the improvements to a singular, industrywide influence, Chris DeRienzo, M.D., AHA's chief physician executive, told Fierce Healthcare the high-level mortality improvements stem from quality initiatives that varied from individual hospital to hospital—for instance, programs focused on early sepsis diagnosis or others cutting down cardiac patient door-to-balloon time.
“This report shows hospitals have made significant improvements on pre-pandemic performance in key patient safety outcomes,” AHA CEO Rick Pollack said in a release. “Hospitals’ commitment to improving patient outcomes and enhancing the patient experience continues to drive these efforts forward.”
The analysis cohort comprised a mix of comprehensive academic medical centers (16%), large, specialized complex care medical centers (21%), smaller complex care medical centers (23%) and community hospitals (41%).
Across these, the report also highlights a jump in preventive screenings for breast cancer (83.1%), cervical cancer (61.2%) and colon cancer (82.3%) from the fourth quarter of 2019 to the first quarter of 2024. The AHA attributed the increases to a combination of screening recommendation changes, less invasive testing options and provider efforts to expand access.
The AHA also pointed to rate decreases among two types of hospital-acquired infections: central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI). Both had spiked at various points in the pandemic and are now lower than pre-pandemic, with CLABSI occurring in 0.7 out of 1,000 encounters and CAUTI in 13.51 of every 10,000 encounters.
A summer release from the Centers for Disease Control and Prevention had noted a rise in these and other antibiotic-resistant hospital infections since 2019—though the agency’s data set from PINC-AI Healthcare Database and the BD Insights Research Database only ran through 2022.
The spring release of Hospital Safety Grades from The Leapfrog Group, an independent watchdog, has pointed to gains on hospital infections as well as patient experience measures that have risen as of data collected in early 2023.