Association of measured quality with financial health among U.S. hospitals

Samuel J. Enumah; Andrew S. Resnick; David C. Chang

doi:10.1371/journal.pone.0266696

Peer Review History

Original SubmissionFebruary 19, 2022
15 Mar 2022 Decision Letter - María del Carmen Valls Martínez, Editor PONE-D-22-05106Association of measured quality with financial health among U.S. hospitalsPLOS ONE Dear Dr. Enumah, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by 5 April. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes Reviewer #3: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: No Reviewer #3: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: 1- In the whole text of the article, the sentences are mostly long, and it is suggested to write more academically to understand the concept better. 2- The method part of the article is very detailed 3-The charts and tables' quality is low, and they are not legible. It is better to be modified in the original version Reviewer #2: Dear authors, i would like to thank you for your such amazing work to measure the association of quality with financial health among U.S hospitals. However, minor comments that needs clarification before accepting this paper. The paper is well written, concise, and logic. Abstract: -Observational study or retrospective study design? -Please define your abbreviation such as IQR... etc. - The first paragraph in result section should be in method section. Introduction - Please remove the word of relationship since you use the word of association in all text. - Please at the last of introduction, summarize all of your study aims. Material and methods - Please report that all 4331 hospitals have enter their data, What about missing numbers? why you excluded both psychiatric and pediatric hospitals? add your study design. - 30-readmission rate? Is it standard? - Analysis part is perfect. Discussion -The first paragraph are perfect and i recommend to add your findings on it. - Lack of comparing your result with previous results, more literature review will enhance your paper. - What should managers of hospital do? If you add recommendation for mangers would be great. References -Please return to PLOS One guidelines if they reported DOI with references. - Double check on your references. For example reference # 10 page number is missing. Figures All figures and footnote are unclear, blurry, and hard to read. Reviewer #3: The topic under study is quite a critical one and the results revealed are a bonus. A generally well written paper that meets the necessary requirements of scientific writing. In terms of presentation of results, I personally find the figures a bit difficult to read, which could be improved. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No Reviewer #3: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0266696.r001
Revision 1
22 Mar 2022 Author Response David C. Chang, PhD, MPH, MBA Associate Professor of Surgery Massachusetts General Hospital Codman Center for Clinical Effectiveness in Surgery 165 Cambridge Street, Suite 403 Boston, MA 02114 Dear Dr. del Carmen Valls Martínez, Thank you for the opportunity to submit a revised version of our manuscript entitled “Association of measured quality with financial health among U.S. hospitals” for consideration as an original research article in PLOS ONE. We appreciate the comments and critiques provided by the Reviewers to enhance our manuscript’s quality. We have pasted their comments below and provided responses to each of their comments in red. As requested, we have attached both a clean version and tracked changes version of our manuscript for further review. Please do not hesitate to contact us with any questions or concerns. Sincerely, David C. Chang, PhD, MPH, MBA Associate Professor of Surgery, Massachusetts General Hospital Codman Center for Clinical Effectiveness in Surgery Email: dchang8@mgh.harvard.edu / Phone: 617-643-6730 Reviewers’ Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: 1- In the whole text of the article, the sentences are mostly long, and it is suggested to write more academically to understand the concept better. Thank you for this comment. We have revised the manuscript to create more concise sentences and to add clarity. 2- The method part of the article is very detailed Thank you for this comment. Our aim in this section was to provide the reader with a thorough understanding of our approach and process in generating our findings. 3-The charts and tables' quality is low, and they are not legible. It is better to be modified in the original version Thank you for this comment. Our sincere apologies for the issue with legibility. We have included higher quality TIFF images with our re-submission. Reviewer #2: Dear authors, i would like to thank you for your such amazing work to measure the association of quality with financial health among U.S hospitals. However, minor comments that needs clarification before accepting this paper. The paper is well written, concise, and logic. Abstract: -Observational study or retrospective study design? Retrospective observational cohort study. We have changed the abstract. Thank you for this comment. -Please define your abbreviation such as IQR... etc. IQR = Interquartile range. We have changed the abstract. Thank you for this comment. - The first paragraph in result section should be in method section. We moved the first sentence of this part of the Abstract Results to the Abstract’s Methods section. Thank you for this comment. Introduction - Please remove the word of relationship since you use the word of association in all text. Thank you for this comment. We have replaced “relationship” with association. - Please at the last of introduction, summarize all of your study aims. Thank you for this comment. We have added an aim to our first sentence of the final paragraph in our Introduction. Material and methods - Please report that all 4331 hospitals have enter their data, What about missing numbers? why you excluded both psychiatric and pediatric hospitals? add your study design. Thank you for these comments. Our S1 Table provides missingness information for the included variables. Our S3 Table in the appendix provides information about hospitals and the observation-years contributed by hospitals. Some hospitals contributed in every year while others contributed fewer observation-years. We excluded psychiatric and pediatric hospitals and long-term care facilities as these facilities have different reimbursement structures compared to acute care hospitals and may not have similarly defined quality goals. -We have added clarification to the Introduction regarding why certain types of facilities were excluded. -We have added clarification to the Introduction on the study design. - 30-readmission rate? Is it standard? Thank you for this comment. Yes, this is a standard measure of quality. It is risk-standardized by the Centers for Medicare & Medicaid Services (CMS). It is derived from “a composite of seven statistical models that are built for groups of admissions that are clinically related.” For further details, please see this online reference from CMS: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Downloads/MMSHospital-WideAll-ConditionReadmissionRate.pdf We have added “risk-standardized” language to the Methods to clarify this. - Analysis part is perfect. Thank you for this comment. Discussion -The first paragraph are perfect and i recommend to add your findings on it. Thank you for this comment. We have aimed in our revisions to clarify our findings. - Lack of comparing your result with previous results, more literature review will enhance your paper. Thank you for this comment. We have added more detail about the previous literature that does exist. We added: “Among 108 acute care hospitals in New York state, Akinleye et al. (2019) identified a positive correlation between financial performance and hospital quality. Our study expands on their work and includes a national population of hospitals and multiple years of financial and quality data.” Overall, there is little available data on this topic, and we believe this helps stress the importance of our disseminating our findings. - What should managers of hospital do? If you add recommendation for mangers would be great. Thank you for this comment. We have added a concise and clear recommendation for managers. “In addition to the previously identified operational factors like occupancy and case mix, we recommend that hospital managers may consider quality as a modifiable factor to focus on as they look for opportunities to achieve positive financial performance and avoid financial distress.” References -Please return to PLOS One guidelines if they reported DOI with references. Thank you for this comment. We have added DOI where it was indicated. - Double check on your references. For example reference # 10 page number is missing. Thank you for this comment. We have reviewed the references and made the appropriate changes. Figures All figures and footnote are unclear, blurry, and hard to read. Thank you for this comment. We apologize for the issue with legibility. We have included higher quality TIFF images with our re-submission. Reviewer #3: The topic under study is quite a critical one and the results revealed are a bonus. A generally well written paper that meets the necessary requirements of scientific writing. In terms of presentation of results, I personally find the figures a bit difficult to read, which could be improved. Thank you for this comment. We apologize for the issue with legibility. We have included higher quality TIFF images with our re-submission. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0266696.r002
25 Mar 2022 Decision Letter - María del Carmen Valls Martínez, Editor Association of measured quality with financial health among U.S. hospitals PONE-D-22-05106R1 Dear Dr. Samuel Joseph Enumah, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, María del Carmen Valls Martínez, Ph.D. Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0266696.r003
Formally Accepted
30 Mar 2022 Acceptance Letter - María del Carmen Valls Martínez, Editor PONE-D-22-05106R1 Association of measured quality with financial health among U.S. hospitals Dear Dr. Enumah: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. María del Carmen Valls Martínez Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0266696.r004

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