Choice of hospital may affect outcome

March 1, 2000
Web posted at: 9:23 AM EST (1423 GMT)

In this story: The power of information Depends on where you live RELATEDS

(WebMD) -- The long-held idea that patients are likely to fare better at hospitals that handle a higher volume of patients who have the same medical problem may now have some backing from a study published in this week's issue of the Journal of the American Medical Association.

The study estimates that in 1997 more than 600 people may have died in California alone simply because they went to hospitals with less experience in treating the patient's specific condition.

Researchers used statistical methods to calculate how much riskier it might be for patients to go to a low-volume hospital compared to a high-volume hospital for 10 types of surgeries -- including heart bypass and coronary angioplasty -- as well as for HIV/AIDS care.

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CNN's Anne McDermott reports on a new study published in the Journal of the American Medical Association that states if you have certain procedures done in high volume hospitals, you are more likely to survive them. Windows Media 28K 80K

Not surprisingly, people were at highest risk when they underwent relatively rare but complex surgeries, such as those for pancreatic and esophageal cancers. And patients were three to five times more likely to die if their hospital performed two or fewer of those types of surgeries per year, the study's authors said.

The risks were lower, but still significant, for more common procedures, such as heart bypass surgery. People who went to a hospital performing fewer than 200 bypasses a year were 40 percent more likely to die.

"There are pretty significant differences in how well hospitals do," said lead author R. Adams Dudley, M.D., M.B.A., assistant professor of medicine at University of California-San Francisco's Institute for Health Policy Studies. "Despite that, there hasn't been a lot of public demand for reporting" on quality measures.

The power of information

Dudley and his colleagues undertook the study to spur more interest in putting such information in the hands of consumers.

But using volume as a discriminator alone can be misleading, Dudley said, since many low-volume hospitals can do a good job. Without more specific data, however, volume serves as a helpful guidepost.

Insurers and government agencies also could use similar findings to insist that patients go to particular medical centers for certain procedures, wrote John D. Birkmeyer, M.D., of the Veterans Affairs Medical Center in White River Junction, Vermont, in an accompanying editorial.

"The potential benefits are too large to ignore," Birkmeyer wrote. "Given the current ad hoc approach to delivering high-risk surgery, it seems that almost any effort aimed at concentrating these procedures in high-volume hospitals would be an improvement."

Some states, like New York, already regulate which procedures hospitals can perform. As a result, a 1989 study found that just 20 percent of its coronary artery bypass graft operations occurred in low-volume hospitals, compared to 65 percent in California, Birkmeyer wrote.

Depends on where you live

Such information on hospital performance should be adjusted to account for how sick patients are to begin with, said Rick Wade, vice president of the American Hospital Association, which supports collecting adjusted data. But even then, it wouldn't be relevant to everyone.

"This is great if you're sitting around with a large number of hospitals to choose from," Wade said. "There are still a whole lot of Americans who don't have that choice."

In a place like California, where researchers concentrated their study, most people live in urban areas and, according to study results, more than half of the Californians who went to a low-volume hospital had a high-volume hospital within 10 miles.

The first step for patients to make the complicated decision of choosing a hospital for a particular procedure or problem is to talk with their patient's doctor, said Wade. He also recommends talking with local nurses who often have very good insight into the capabilities of doctors and medical centers.

Dudley said patients should ask hospitals how many of their type of surgery or problem they've handled -- a number that medical centers should be able to easily provide. Places like California also have reports prepared by state agencies that attempt to compare hospital outcomes for such common illnesses as heart attacks.

© 2000 Healtheon/WebMD. All rights reserved.

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