'High-Intensity' Hospitals Save More Elderly After Surgery
But downside includes longer hospital stays, fewer days in hospice
THURSDAY, Oct. 2, 2014 (HealthDay News) -- Failure-to-rescue rates for elderly patients after major surgery are lower at hospitals with "high care intensity" compared with hospitals that display less intensity, according to research published online Oct. 1 in JAMA Surgery.
Researchers used national Medicare data to identify 706,520 patients aged 65 and older who underwent major surgery at 2,544 hospitals. The investigators noted their outcomes and any major complications. The researchers then judged each hospital's aggressiveness using measures taken from the Dartmouth Atlas of Healthcare, in particular the Hospital Care Intensity (HCI) Index. This index evaluates a hospital's willingness to aggressively treat Medicare patients during their last two years of life.
The intensity of care provided by hospitals varied dramatically across the country, with the most aggressive hospitals displaying 10 times the intensity of the most passive hospitals. Overall, the researchers found a 5 percent decrease in failure-to-rescue rates at high- compared with low-HCI hospitals. But the highly aggressive hospitals also: ran up higher Medicare costs, charging more than $47,000 per inpatient compared with about $29,500 per inpatient for the least intense hospitals; kept patients longer; had more inpatient deaths; and were less likely to refer patients to hospice.
Senior author Amir Ghaferi, M.D., assistant professor of surgery and chief of the Division of Veterans Administration at the University of Michigan Health Systems, hopes the study will promote discussion of how best to use a hospital's resources when caring for people who have undergone major surgery. Utilization of resources by itself doesn't lead to safer outcomes when it comes to major surgery, he said. "Hospitals need to pay attention not necessarily to how much they're doing as to how they are coordinating that care," he told HealthDay. "How can we develop a system based on teamwork and cooperation, where we do pick up problems sooner?"