UNIVERSAL HEALTH SERVICES INC

Reporting Organization
UNIVERSAL HEALTH SERVICES INC
Report Period
01/01/2024 – 12/31/2024
Hospital / Hospital System
Hospital System
Report Type
General Acute Care Hospital

Hospitals

Hospital Count: 4

1. Top 10 Disparities

The following table lists the ten largest health equity disparities identified for this reporting period.

Disparities for each hospital equity measure are identified by comparing the rate ratios by stratification groups. Rate ratios are calculated differently for measures with preferred low rates and those with preferred high rates. Rate ratios are calculated after applying the California Health and Human Services Agency's "Data De-Identification Guidelines (DDG)," dated September 23, 2016.

The table below highlights the ten widest health equity disparities identified by hospitals and hospital systems during this reporting period. Measure names have been shortened for display purposes. To view each measure in full, please download the complete Hospital Equity Report using the link below.

Measure Stratification Stratification Group Stratification Group Rate Reference Group Reference Rate Rate Ratio
1. HCAI 30-Day readmission NOBH
Age (excluding maternal measures) 65 and older 15.2% 18 to 34 4.6% 3.30
2. HCAI 30-Day readmission SUD
Preferred Language English Language 18.7% Spanish Language 12.2% 3.10
3. HCAI 30-Day readmission NOBH
Age (excluding maternal measures) 50 to 64 13.0% 18 to 34 4.6% 2.80
4. HCAI 30-Day readmission
Expected Payor Medicare 16.2% Self-Pay 5.8% 2.80
5. HCAI 30-Day readmission NOBH
Expected Payor Medicare 15.8% Private 5.7% 2.80
6. HCAI 30-Day readmission
Age (excluding maternal measures) 65 and older 15.5% 18 to 34 6.4% 2.40
7. HCAI 30-Day readmission
Expected Payor Medicaid 14.1% Self-Pay 5.8% 2.40
8. HCAI 30-Day readmission NOBH
Preferred Language Middle Eastern Languages 18.3% Other/Unknown 7.7% 2.40
9. AHRQ pneumonia mortality rate
Race and/or Ethnicity Hispanic or Latino 58.3% White 50.0% 2.30
10. HCAI 30-Day readmission
Age (excluding maternal measures) 50 to 64 14.8% 18 to 34 6.4% 2.30

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2. Equity Plan

UHS/Southwest Healthcare partners with community organizations to help ensure healthcare equity — identifying the unique needs of our respective communities and developing programs, services and events that fully meet and fully address these needs. The top 10 disparities identified focus on readmissions. Each of our facilities have a multidisciplinary readmission committee. The focused actions include transitioning care to a Primary Care Provider to support ongoing care, connecting patients with primary care providers and setting appointments for patients that have PCP's. We have implemented processes to strengthen the discharge medication reconciliation process, medication education, and working with patients on any barriers to picking up medications. We have created partnerships with transportation companies, and Pharmacies for Meds to Beds program. We perform post discharge phone calls to reinforce care plans, provide education and provide support for any discharge actions. The action plan for 2026 includes a Failure Mode Effect Analysis (FMEA) performance improvement project that will focus on 0-7 day readmissions.

4. Download Equity Measures Report

Click on the link below to download the equity measures report.

Hospital Equity Measures Report Download

Click on the link below to download all equity measures reports.