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Association of hospital spending intensity with mortality and readmission rates in Ontario hospitals.
- Source :
-
JAMA [JAMA] 2012 Mar 14; Vol. 307 (10), pp. 1037-45. - Publication Year :
- 2012
-
Abstract
- Context: The extent to which better spending produces higher-quality care and better patient outcomes in a universal health care system with selective access to medical technology is unknown.<br />Objective: To assess whether acute care patients admitted to higher-spending hospitals have lower mortality and readmissions.<br />Design, Setting, and Patients: The study population comprised adults (>18 years) in Ontario, Canada, with a first admission for acute myocardial infarction (AMI) (n = 179,139), congestive heart failure (CHF) (n = 92,377), hip fracture (n = 90,046), or colon cancer (n = 26,195) during 1998-2008, with follow-up to 1 year. The exposure measure was the index hospital's end-of-life expenditure index for hospital, physician, and emergency department services.<br />Main Outcome Measures: The primary outcomes were 30-day and 1-year mortality and readmissions and major cardiac events (readmissions for AMI, angina, CHF, or death) for AMI and CHF.<br />Results: Patients' baseline health status was similar across hospital expenditure groups. Patients admitted to hospitals in the highest- vs lowest-spending intensity terciles had lower rates of all adverse outcomes. In the highest- vs lowest-spending hospitals, respectively, the age- and sex-adjusted 30-day mortality rate was 12.7% vs 12.8% for AMI, 10.2% vs 12.4% for CHF, 7.7% vs 9.7% for hip fracture, and 3.3% vs 3.9% for CHF; fully adjusted relative 30-day mortality rates were 0.93 (95% CI, 0.89-0.98) for AMI, 0.81 (95% CI, 0.76-0.86) for CHF, 0.74 (95% CI, 0.68-0.80) for hip fracture, and 0.78 (95% CI, 0.66-0.91) for colon cancer. Results for 1-year mortality, readmissions, and major cardiac events were similar. Higher-spending hospitals had higher nursing staff ratios, and their patients received more inpatient medical specialist visits, interventional (AMI cohort) and medical (AMI and CHF cohorts) cardiac therapies, preoperative specialty care (colon cancer cohort), and postdischarge collaborative care with a cardiologist and primary care physician (AMI and CHF cohorts).<br />Conclusion: Among Ontario hospitals, higher spending intensity was associated with lower mortality, readmissions, and cardiac event rates.
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Colonic Neoplasms therapy
Female
Health Expenditures statistics & numerical data
Heart Failure therapy
Hip Fractures therapy
Humans
Longitudinal Studies
Male
Middle Aged
Myocardial Infarction therapy
Ontario epidemiology
Quality of Health Care
Treatment Outcome
Young Adult
Colonic Neoplasms mortality
Economics, Hospital
Heart Failure mortality
Hip Fractures mortality
Hospital Costs statistics & numerical data
Myocardial Infarction mortality
Patient Readmission statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1538-3598
- Volume :
- 307
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- JAMA
- Publication Type :
- Academic Journal
- Accession number :
- 22416099
- Full Text :
- https://doi.org/10.1001/jama.2012.265