Higher Spending Tied to Better Outcomes in Ontario
TUESDAY, March 13 (HealthDay News) -- Higher spending hospitals
in Canada's universal care health system have lower rates of
patient deaths and readmissions, and provide a better quality of
care for severely ill patients, according to a new study.
Previous studies that examined the link between hospital
spending and quality of care in the United States and other
countries produced conflicting results, and the effects of higher
spending by hospitals in a universal health care system were
unknown, according to Therese Stukel, of the Institute for Clinical
Evaluative Sciences in Toronto, and colleagues.
For the new study, Stukel's team examined data on patients older
than age 18 who were admitted to hospitals in the province of
Ontario between 1998 and 2008 for treatment of heart attack,
congestive heart failure, hip fracture or colon cancer.
In the highest- and lowest-spending hospitals, respectively, the
30-day death rate among patients was 12.7 percent vs. 12.8 percent
for heart attack, 10.2 percent vs. 12.4 percent for congestive
heart failure, 7.7 percent vs. 9.7 percent for hip fracture, and
3.3 percent vs. 3.9 percent for colon cancer.
In addition, the 30-day rate for major cardiac events was 17.4
percent vs. 18.7 percent for patients with heart attack and 15
percent vs. 17.6 percent for those with congestive heart failure at
the highest- and lowest-spending hospitals, respectively.
The 30-day readmission rate was 23.1 percent vs. 25.8 percent
for patients with hip fracture and 10.3 percent vs. 13.1 percent
for those with colon cancer, the investigators found.
Results for death rates, readmissions and major cardiac events
after one year were similar, according to the research in the March
14 issue of the
Journal of the American Medical Association.
The study authors reported that certain factors were noted among
higher-spending hospitals, including that they tended to be
higher-volume teaching or community hospitals; located in cities;
affiliated with regional cancer centers; and able to provide
specialized services. In addition, these facilities were more
likely to have higher nursing staff ratios, and admitted patients
had longer stays, were less likely to be placed in intensive care
and had more specialist visits.
Compared to Ontario, the United States has a three to four times
higher supply of specialized medical technology, such as CT and MRI
scanners, per person, but a similar supply of acute care beds and
nurses, the researchers noted in a journal news release.
"Ontario's 2001 population rates of cardiac testing and revascularization lagged behind corresponding 1992 U.S. rates and paralleled the supply of cardiologists and catheterization facilities," the study authors noted in the release.
"It is therefore possible that Canadian hospitals, with fewer specialized resources, selective access to medical technology, and global budgets, are using these resources more efficiently, especially during the inpatient episode for care-sensitive conditions," the authors said. "Canada's health care expenditures per capita are about 57 percent of those in the United States. At this spending level, there might still be a positive association between spending and outcomes."
The U.S. Agency for Healthcare Research and Quality offers a
guide to health care quality.
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