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JAMA Surg. 2014 Dec;149(12):1254-9. doi: 10.1001/jamasurg.2014.552.

The association between hospital care intensity and surgical outcomes in medicare patients.

Author information

1
Department of Surgery, University of Michigan, Ann Arbor.

Abstract

IMPORTANCE:

Hospitals' care intensity varies widely across the United States. Payers and policy makers have become focused on promoting quality, low-cost, efficient health care.

OBJECTIVE:

To evaluate whether increased hospital care intensity (HCI) is associated with improved outcomes following major surgery.

DESIGN, SETTING, AND PARTICIPANTS:

Using national Medicare data in this retrospective cohort study, we identified 706,520 patients at 2544 hospitals who underwent 1 of 7 major cardiovascular, orthopedic, or general surgical operations.

EXPOSURE:

The HCI Index, which is validated and publicly available through the Dartmouth Atlas of Healthcare.

MAIN OUTCOMES AND MEASURES:

Risk- and reliability-adjusted mortality, major complication, and failure-to-rescue rates.

RESULTS:

Hospital care intensity varied 10-fold. High-HCI hospitals had greater rates of major complications when compared with low-HCI centers (risk ratio, 1.04; 95% CI, 1.03-1.05). There was a decrease in failure to rescue at high compared with low-HCI hospitals (risk ratio, 0.95; 95% CI, 0.94-0.97). Using multilevel-models, HCI reduced the variation in failure-to-rescue rates between hospitals by 2.7% after accounting for patient comorbidities and hospital resources. Patients treated at high-HCI hospitals had longer hospitalizations, more inpatient deaths, and lower hospice use during the last 2 years of life.

CONCLUSIONS AND RELEVANCE:

Failure-to-rescue rates were lower at high-care intensity hospitals. Conversely, care intensity explains a very small proportion of variation in failure-to-rescue rates across hospitals.

PMID:
25272279
DOI:
10.1001/jamasurg.2014.552
[Indexed for MEDLINE]

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