Which hospitals deliver best care for seniors?
Researchers say bigger is better
Orthopedic procedures are not only costly procedures, but poor orthopedic outcomes often lead to nursing home admissions in the elderly. If you want to avoid premature nursing home admissions and achieve the best possible outcomes for older clients undergoing orthopedic procedures, send them to one of the 100 top orthopedic benchmark hospitals or just about any teaching hospital, suggests a new study recently released by the HCIA-Sachs Institute, the research and education division of the health care consulting firm HCIA-Sachs, based in Evanston, IL, and the Human Motion Institute in Canonsburg, PA.
"The obvious goal of treatment," notes study director Jean Chenoweth, executive director of the HCIA-Sachs Institute, "is to help patients return to a normal life to the greatest extent possible. The study shows that 100 top orthopedic hospitals are enabling significantly more orthopedic patients to return home rather than be institutionalized. These hospitals also are demonstrating lower complication rates and lower overall costs."
Researchers used a computerized review and analysis of more than 700,000 Medicare orthopedic cases, using the following clinical and financial measures:
• risk-adjusted mortality rates;
• risk-adjusted complication rates;
• number of unique patients receiving orthopedic services;
• average length of stay at hospital, adjusted for illness acuity;
• cost per patient, adjusted for illness severity and local wage differences;
• percentage of patients who came from and were discharged to home.
The study identifies the 100 best performing hospitals for orthopedic services in 2000 and finds that these 100, as well as teaching hospitals overall, achieve better outcomes at lower cost even though they treat more complex cases. The study focuses on outcomes for four established technical procedures: total knee replacement, total hip replacement, partial hip replacement, and intertrochanteric fracture.
Findings include:
• Benchmark teaching hospitals with orthopedic residency programs are most likely to release orthopedic patients home after hospitalization, rather than discharging them to a skilled nursing or other short-term care facility.
• More than 65% of women compared to roughly 50% of men treated for the procedures studied remained institutionalized after hospital stays. Women in the study were more likely to be discharged to a skilled nursing facility or other short-term care facility. Researchers surmise that one possible reason for this finding is that women are more likely to outlive men, implying that more elderly men than elderly women may have a spouse at home to provide support and care.
• Hospitals with the largest orthopedic programs have the lowest death and complication rates.
Study excerpts and a list of the top 100 orthopedic hospitals listed in alphabetical order are available on the Internet at www.100TopHospitals.com.
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