By Jane Norman, CQ HealthBeat Associate Editor
May 22, 2009 -- In a study that could have implications for the health overhaul in Congress, researchers have found that there's not necessarily a link between more expensive hospital services and the quality of care for chronically ill patients. In some instances, the care actually declined when spending went up.
The study on the Web site of Health Affairs, a public policy magazine, was conducted by researchers from Dartmouth College and Harvard University and analyzed care for Medicare beneficiaries in their last two years of life. Included were 2,172 U.S. hospitals across the country. The National Institute on Aging provided funding.
Laura Yasaitis of Dartmouth said in a statement that the researchers found no evidence that hospitals with higher spending on patients at the end of life provided better care, whether the hospitals were scattered across the country or in one region, or were academic medical centers. "In fact, in some cases hospitals that spent more provided worse care," said Yasaitis, a student at Dartmouth Medical School and a researcher at the Dartmouth Institute for Health Policy and Clinical Practice.
The other researchers were Elliott Fisher and Jonathan Skinner of Dartmouth and Amitabh Chandra at Harvard's Kennedy School of Government. Chandra said some hospitals in the same region provided exemplary care for lower costs, pointing to the need for better reporting of both costs and quality and a greater understanding of what leads to an improvement in performance.
Lawmakers working on health care are focused on finding ways to reduce rising costs in the U.S. health care system and at the same time provide a higher quality of care and expanded access. President Obama has said his priorities are to control costs, guarantee doctor choice, and assure high-quality, affordable health care.
The study looked at end-of-life spending for patients with three common conditions—heart attacks, pneumonia, and congestive heart failure. It took the analysis down to a hospital-by-hospital level, rather than studies in the past done at the regional level, though individual hospitals were not named.
Average end-of-life spending was $16,059 for the lowest-spending fifth of hospitals and the average was $34,742 in the highest-spending fifth of hospitals.
Quality was measured by using data from a program that measures the percentage of patients receiving a specific, often low-cost, evidenced-based therapy. That would include, for example, whether aspirin was given at arrival and discharge to those who had suffered heart attacks, and whether patients with pneumonia received a blood culture before being administered their first antibiotic.
For all of the quality indicators studied, the association with spending was either zero or negative, the study said. The researchers also said their study might be limited because the quality measures they used might penalize hospitals that treat sicker patients, and also because they looked at process-of-care measures rather than outcomes.
Quality was measured by using data from a program that measures the percentage of patients receiving a specific, often low-cost, evidenced-based therapy. That would include, for example, whether aspirin was given at arrival and discharge to those who had suffered heart attacks, and whether patients with pneumonia received a blood culture before being administered their first antibiotic.
For all of the quality indicators studied, the association with spending was either zero or negative, the study said. The researchers also said their study might be limited because the quality measures they used might penalize hospitals that treat sicker patients, and also because they looked at process-of-care measures rather than outcomes.
May 22, 2009 -- In a study that could have implications for the health overhaul in Congress, researchers have found that there's not necessarily a link between more expensive hospital services and the quality of care for chronically ill patients. In some instances, the care actually declined when spending went up.
The study on the Web site of Health Affairs, a public policy magazine, was conducted by researchers from Dartmouth College and Harvard University and analyzed care for Medicare beneficiaries in their last two years of life. Included were 2,172 U.S. hospitals across the country. The National Institute on Aging provided funding.
Laura Yasaitis of Dartmouth said in a statement that the researchers found no evidence that hospitals with higher spending on patients at the end of life provided better care, whether the hospitals were scattered across the country or in one region, or were academic medical centers. "In fact, in some cases hospitals that spent more provided worse care," said Yasaitis, a student at Dartmouth Medical School and a researcher at the Dartmouth Institute for Health Policy and Clinical Practice.
The other researchers were Elliott Fisher and Jonathan Skinner of Dartmouth and Amitabh Chandra at Harvard's Kennedy School of Government. Chandra said some hospitals in the same region provided exemplary care for lower costs, pointing to the need for better reporting of both costs and quality and a greater understanding of what leads to an improvement in performance.
Lawmakers working on health care are focused on finding ways to reduce rising costs in the U.S. health care system and at the same time provide a higher quality of care and expanded access. President Obama has said his priorities are to control costs, guarantee doctor choice, and assure high-quality, affordable health care.
The study looked at end-of-life spending for patients with three common conditions—heart attacks, pneumonia, and congestive heart failure. It took the analysis down to a hospital-by-hospital level, rather than studies in the past done at the regional level, though individual hospitals were not named.
Average end-of-life spending was $16,059 for the lowest-spending fifth of hospitals and the average was $34,742 in the highest-spending fifth of hospitals.
Quality was measured by using data from a program that measures the percentage of patients receiving a specific, often low-cost, evidenced-based therapy. That would include, for example, whether aspirin was given at arrival and discharge to those who had suffered heart attacks, and whether patients with pneumonia received a blood culture before being administered their first antibiotic.
For all of the quality indicators studied, the association with spending was either zero or negative, the study said. The researchers also said their study might be limited because the quality measures they used might penalize hospitals that treat sicker patients, and also because they looked at process-of-care measures rather than outcomes.
Quality was measured by using data from a program that measures the percentage of patients receiving a specific, often low-cost, evidenced-based therapy. That would include, for example, whether aspirin was given at arrival and discharge to those who had suffered heart attacks, and whether patients with pneumonia received a blood culture before being administered their first antibiotic.
For all of the quality indicators studied, the association with spending was either zero or negative, the study said. The researchers also said their study might be limited because the quality measures they used might penalize hospitals that treat sicker patients, and also because they looked at process-of-care measures rather than outcomes.