Is cardiac care better at specialty hospitals?
Data adjusted for specialty patients’ better health
Specialty heart hospitals may not provide better or more efficient cardiac care than general hospitals, according to a recent study in the New England Journal of Medicine.1
The authors of the study examined claims data for nearly 43,000 Medicare beneficiaries undergoing two heart procedures at specialty heart hospitals and general hospitals in 2000 and 2001.
After adjusting for the better health of the specialty hospital patients, they found that patient mortality rates and lengths of stay were comparable for specialty and general hospitals that perform similar volumes of the procedures.
"The mortality in the specialty hospitals is not statistically significantly lower once you account for the healthier patients and the greater procedural volumes," explains Peter Cram, MD, MBA, assistant professor of medicine in the division of general medicine at the University of Iowa College of Medicine in Iowa City, and the study’s lead author.
"Specialty cardiac hospitals appear to be admitting healthier and wealthier patients than the general hospitals, and they perform many more bypass surgeries and angioplasties per year than general hospitals," he notes.
Do more; get better?
"It’s been well documented in the past that, all things being equal, the more procedures a hospital does the better they do, be that esophageal, pancreatic, angioplasty — whatever," Cram asserts.
"The specialty hospitals are doing many more of these procedures, thus you would expect them to do better — and they do. But our findings suggest there is nothing inherent in the specialization that makes them better per se," he adds.
If specialization may not automatically make a facility better, what does that mean to quality managers of general hospitals that may be competing against such facilities? Will patients automatically choose a specialty hospital?
"There are growing amounts of data available to the public on outcomes for angioplasty and bypass surgery," Cram notes.
"CMS just posted some data on the web for all heart attacks. Patients should look at the hospitals in their area — then they’d have to choose the one that does most the volume." In general, those would be the large tertiary care medical centers and specialty medical centers, he points out.
Data breakdown instructive
A closer look at the study data provides some interesting information for competition-minded quality managers, Cram continues.
"When we actually stratified hospitals and compared low-volume specialty hospitals with low-volume hospitals in general, the specialty hospitals were not statistically significantly better," he notes, reaffirming the thesis that specialty facilities are not automatically superior.
"When we compared high-volume general hospitals and high-volume specialty hospitals, there were similar findings; we did not find any data proving specialty hospitals are statistically significantly better," Cram explains.
If that is true, what does make the quality of cardiac care at one facility superior to the quality at another? "There, you’re asking about one of the real mysteries," he concedes.
"It’s probably, in truth, other measures of quality beyond volume, such as the use of aspirin, beta-blockers, ACE inhibitors, appropriate techniques when people are performing stenting or bypass surgery. But those things are very hard to measure," Cram notes.
He adds one caveat: While the specialty hospitals were not statistically significantly better than the general hospitals, they did have a slight edge.
"It’s kind of like one candidate in a political race leading the other, but their lead is within the margin of error," he explains. "They may be ahead, but they are nonstatistically significantly better."
Reference
- Cram P, Rosenthal GE, Vaughan-Sarrazin MS. Cardiac revascularization in specialty and general hospitals. N Engl J Med 2005; 352:1,454-1,462.
Need More Information?
For more information, contact:
- Peter Cram, MD, MBA, Assistant Professor of Medicine, Division of General Medicine, 200 Hawkins Drive, University of Iowa College of Medicine, Iowa City, IA 52242. Phone: (319) 353-6894. Fax: (319) 356-3086. E-mail: [email protected].
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