Patient outcomes worsen in hospitals acquired by private equity firms

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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.   
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1. Patient outcomes worsen in hospitals acquired by private equity firms

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-03471

URL goes live when the embargo lifts             

A difference-in-differences analysis examined hospital staffing and patient outcomes after private equity acquisition, focusing on emergency departments (EDs) and intensive care units (ICUs). This study found that private equity hospitals reduced both salary expenditures and total staffing compared to nonprivate equity hospitals. Likely as a result, private equity hospitals experienced an increase in patient transfers to other hospitals, shortened ICU stays, and increased ED mortality. These changes in patient outcomes could reflect a decrease in capacity to deliver care due to the staffing cuts. The analysis is published in Annals of Internal Medicine. 

Researchers from the University of Pittsburgh, University of Chicago, and Harvard Medical School analyzed hospital cost report data collated by the RAND Corporation between 2007 and 2019 and 100% Medicare Fee-for-Service Part A and Part B claims between 2009 and 2019 from hospitals acquired by private equity firms between 2010 and 2017 and matched control hospitals not acquired by private equity. Primary staffing-related outcomes were salary expenditures per bed day for both the ED and ICU. Secondary outcomes included total hospital salary expenditures and full-time equivalent employees. Primary clinical outcomes were ED and ICU mortality, ED and ICU transfers to other acute care hospitals, and ICU length of stay. Compared to matched non-acquired control hospitals, private equity hospitals reduced their ED and ICU salary expenditures by 18.2% and 15.9% of preacquisition levels. Private equity hospitals reduced their average full-time employees whereas control hospitals increased their average full-time employees. In-hospital mortality among those treated in the ED increased by 13.4% at private equity hospitals, while decreasing at control hospitals. At private equity hospitals, ED and ICU transfers to acute care hospitals increased by 4.2% and 10.2% from baseline, respectively. ICU length of stay decreased by 4.7%. These findings suggest reductions in salary expenditures could represent a key mechanism by which cost cutting after private equity acquisition contributes to changes in clinical care and patient outcomes. 

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Zirui Song, MD, PhD Zirui Song, MD, PhD please email Jake Miller at jake_miller@hms.harvard.edu. 

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2. Palliative care app for caregivers improves quality of life among patients with terminal cancer

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-02346

URL goes live when the embargo lifts             

An open-label, randomized trial assessed whether providing access for family caregivers to a palliative care educational app could improve upon usual care for patients with incurable cancer. Through the WeChat app, family caregivers had access to nursing information and multimedia education on managing symptoms and adverse effects delivered in a fast and concise manner. Added to usual care, the app was shown to enhance health-related quality of life for homebound patients after 2 months.  In addition, app analytics showed intensive engagement among family caregivers, and several family caregivers noted that the educational app helped them better identify proximal signs for predicting distal outcomes. The results are published in Annals of Internal Medicine.

Researchers from Fudan University and colleagues studied data from 147 adult patient–caregiver pairs from Fudan University Shanghai Cancer Center in Shanghai, China between 28 July and 3 November 2023 to determine if an educational app could improve health-related quality of life, primarily assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and secondarily assessed via the Hamilton Anxiety Rating Scale (HAM-A). Patients were at least 18 years old with incurable cancer and had family caregivers able to provide stable home care. The patient–caregiver pairs were randomly assigned to use the palliative care educational app installed on WeChat plus palliative usual care or usual care alone. The researchers found that after 2 months, the intervention group improved their EORTC QLQ-C30 score whereas the control group’s EORTC QLQ-C30 score decreased, indicating a moderate improvement in health-related quality of life among those in the intervention group. A similar effect was seen among both groups in changes to HAM-A scores, indicating that patients in the intervention group improved from significant anxiety at baseline to mild anxiety at month two.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Xingdong Chen, PhD please email Hao Xue at hxue24@m.fudan.edu.cn. 

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3. Firearm-related homicides and suicides decreased in New Zealand after enacting policies restricting firearm access

Other population-level firearm mortality trends reveal opportunities for strengthening firearm restrictions and improving firearm education

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-03483

URL goes live when the embargo lifts             

A retrospective cohort study examined individual- and population-level risks for firearm related offenses, hospitalizations, and deaths in New Zealand (NZ) and summarized annual costs. The study found that firearm related deaths decreased between 2000 and 2018; however, population-level data indicates Māori people have a higher risk of firearm-related homicide and hospitalization than other groups. Additionally, average costs of firearm-related hospitalizations were $871,000 per year. The results underscore the importance of improving firearm-related harm reduction in NZ. The study is published in Annals of Internal Medicine. 

Since being introduced, there have been many changes to the Arms Act 1983 in NZ in response to mass shootings and calls for stricter firearm regulations. Researchers from University of Otago and colleagues studied population-level data on firearm-related homicide and suicide (1980 to 2020) from the Chief Coroner, population-level data on homicides (2004 to 2024) and firearm licenses (2010 to 2023) from NZ police, and anonymized individual-level hospitalization and mortality data for 2000 to 2018 from the Ministry of Health. They found that the combined rate of firearm related homicides and suicides decreased from 31.0 deaths per million people in 1992, when the Arms Amendment Act of 1992 was introduced, to 9.4 deaths per million people in 2018. The firearm-related suicide rate steadily decreased from 26.6 deaths per million in 1992 to 8.4 deaths per million in 2020. Between 2000 and 2018, firearm related deaths and hospitalizations were primarily among males. European/Other and Māori populations had the highest rates of firearm mortality. Māori populations had a higher risk for firearm death due to assault and lower risk for death due self-harm than other groups, possibly reflecting differences in levels of firearm access. Firearm-related mortality costs for adults increased from $780,000 in 2015 to more than $1 million in 2018. A sensitivity analysis that included population-level data from NZ police through mid-2024 found that the firearm-related homicide rate has increased in recent years, with the 2023-2024 rate reaching the highest levels seen since 2006-2007. The authors say that current rules restricting access to firearms should be maintained and strengthened, and education to limit firearm-related harm should be targeted to Māori and European/Other men and young adults with any access to firearms, particularly in rural areas.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Andrew Anglemyer, PhD please email Cheryl Norrie at cheryl.norrie@otago.ac.nz. 

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4. Incidence of specific antibiotic-resistant bacteria increased 69% between 2019 and 2023

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-02404

URL goes live when the embargo lifts             

A brief research report found that incidence of a specific antibiotic-resistant bacteria increased 69% between 2019 and 2023. The report described trends in incidence of carbapenemase-producing carbapenem-resistant Enterobacterales (CRE) (CP-CRE) clinical isolates reported to the Antimicrobial Resistance Laboratory Network of the Centers for Disease Control and Prevention (CDC) during the timeframe. The findings showed that in 29 states with mandated CRE isolate reporting, incidence of CP-CRE cultures surged between 2019 and 2023, primarily due to NDM (New Delhi metallo-b-lactamase). The findings indicate that the changing epidemiology of CP-CRE poses significant challenges for managing CRE infection. The study is published in Annals of Internal Medicine.   

Carbapenemases drive the spread of CRE. The type of carbapenemase affects treatment options, as fewer agents are active against CRE with NDM and other metallo-b-lactamases compared to KPC (Klebsiella pneumoniae carbapenemase). Researchers from the National Center for Emerging and Zoonotic Infectious Diseases at the CDC developed an open cohort of 29 states with mandated CRE isolate submission. They estimated annual aggregate and state-specific CP-CRE incidence rates overall and by carbapenemase. The researchers found that the annual unadjusted incidence of CRE increased by 18% (IRR, 1.18 [95% CI, 1.14–1.22]) from 2019 to 2023, and when adjusted for age, the incidence of CP-CRE increased by 69% (IRR, 1.69 [CI, 1.61–1.78]). The age-adjusted incidence of NDM-CRE increased 461% (IRR, 5.61 [CI, 4.96–6.36]). KPC-CRE incidence decreased from 2019 to 2020 and then rose. By 2023, NDM-CRE incidence was comparable to KPC-CRE, and NDM became the most common carbapenemase in E coli. The researchers note that understanding local CRE epidemiology and integrating mechanism testing into laboratory workflows may help ensure patients receive timely, appropriate therapy.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Danielle A. Rankin, PhD, MPH please email tvk2@cdc.gov.

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