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High adverse event rates are a signal of potentially low-quality care that imposes burdens on patients, families, and hospitals. In this article, we examine the relationship between the distinct characteristics of teaching hospitals with adverse event rates among pediatric patients, controlling for patient complexity and severity using 2009-2011 Nationwide Inpatient Sample data from the Agency for Healthcare Research and Quality. We hypothesize that adverse event rates increase with the availability of more complex services and technologies (transplantation and pediatric open-heart surgery); increase as experience of providers decreases (July effect); and increase with residents per bed, a measure of both average provider inexperience and congestion. Using multilevel analysis, we find empirical evidence in support of our three hypotheses. We find that in environments where more learning occurs, more mistakes are made. Identifying high-performing hospitals with large residency programs and complex service lines that have made progress in patient safety and then studying how they have done so should become a priority. These findings should then be adapted within other hospitals through publicly funded mechanisms to improve the quality of care for all children. [ABSTRACT FROM AUTHOR]

Introduction: Adults with type 2 diabetes (T2D) often experience musculoskeletal disorders (MSDs), which complicate health care provision and negatively impact their health and health care utilization and expenditure. The objective of this study was to estimate the incremental health care utilization and expenditure associated with MSD among adult T2D patients in the United States overall and by race/ethnicity., Methods: A sample (unweighted n=6205) of noninstitutionalized US adults with a T2D diagnosis was obtained from the Medical Expenditure Panel Survey (MEPS), panels 2015-2016 to 2019-2020. Propensity score matching (PSM) was used to reduce selection bias between participants with and without MSD. Differences in health care utilization were estimated using negative binomials, while expenditures were estimated using generalized linear models and 2-part models. Outcomes were estimated overall and by race and ethnicity., Results: Among the sample of patients with T2D before PSM, 52% had MSD. In the matched sample, increased utilization associated with MSD occurred across all health care service types, with prescription medications (13.31; 95% CI: 11.12, 15.50) having the largest increase. The increased total expenditure associated with MSD among T2D patients was $5712 (95% CI: $4278, $7147), and the major drivers were office and inpatient expenditures. Increased total expenditure associated with MSD was highest among Hispanic patients ($8490; 95% CI: $4744, $12,237)., Conclusions: MSD is associated with increased utilization and expenditure among T2D patients, particularly Hispanics. Efforts targeting earlier recognition and management of MSD may reduce excess utilization and expenditure, and also racial/ethnic disparities., Competing Interests: The authors declare no conflict of interest., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)