This study used discharge data from hospitals in 11 states to see whether the rate of adverse patient safety events within the same hospital differed based on a patient's insurance status. Risk-adjusted rates of 13 AHRQ Patient Safety Indicators (PSIs) were measured. Patients with private insurance experienced significantly fewer adverse events compared to Medicare and Medicaid patients. However, these findings were not consistent across event types—Medicaid patients had lower event rates on two of the PSIs. These findings raise serious concerns about quality disparities within the same hospital, though there are many methodological limitations to the study such as the ability to accurately risk-adjust patients based on discharge data and whether PSIs provide a valid measurement of safety. A prior AHRQ WebM&M perspective reviewed different methods for measuring patient safety and the limitations of each tool.

Implementation of clinical information technology remains slow in both ambulatory and hospital settings, due to cost issues and concern that IT may not lead to improvements in patient care. Prior studies in this area have found improvements in clinical outcomes associated with computerized provider order entry, but other high-profile failures have lessened enthusiasm for rapid IT implementation. This study, conducted at 41 Texas hospitals, provides support for IT's clinical benefits. Hospitals with electronic health records had lower overall mortality rates, and computerized order entry—particularly when combined with decision support—was associated with lower mortality rates in common inpatient conditions as well as lower rates of inpatient complications and costs. An accompanying editorial by David Bates discusses the policy implications of the study.