Variations in how hospital resources appear to be utilized across the United States have been a central part of the existing discussion on health care development. A latest study by the University of California’s five medical centers and Cedars-Sinai Medical Center in Los Angeles was believed to have examined differences in medical treatment, cost and patient outcomes between hospitals.
Apparently, this study takes a more detailed look into the extensive variation documented by recent studies on hospital utilization among constantly ill Medicare beneficiaries at the end of life.
Among the six California teaching hospitals, study experts were believed to have found lower mortality rates at six months for elderly Medicare heart failure patients hospitalized at hospitals who used more health care resources in contrast to those at hospitals that used fewer resources.
This finding seems to suggest that more resource-intensive care may improve outcomes among certain patients with heart failure. Apparently, heart failure is known to be the most common cause of hospitalization and death among Medicare beneficiaries.
The study was believed to have made use of a ‘looking forward’ approach that analyzed all hospitalized heart failure patients. It was observed that this approach was compared with the ‘looking back’ approach which was used in earlier studies of variation among hospitals. This ‘looking back’ approach is known to be an approach that examined only hospitalized individuals in the last six months of life.
“Two major concerns with the ‘looking back’ approach are that, one, it cannot identify differences across hospitals in health outcomes, and it ignores the possibility that resource-intensive care may influence survival; and two, it assumes that patterns of resource use among deceased individuals accurately reflect patterns of resource use among all individuals,” says lead author of the study, Dr. Michael Ong, an assistant professor in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA.
“We found with the ‘looking forward’ approach that mortality was lower for heart failure patients at the hospitals that had greater resource use,” continues Ong.
“This positive association between increased resource use and reduced mortality would not be observed with a ‘looking back’ approach. In addition, changing to the ‘looking forward’ approach resulted in nearly half the amount of variation in resource use generated by the ‘looking back’ approach,” says one of the study’s authors, Dr. J. Thomas Rosenthal, chief medical officer at Ronald Reagan UCLA Medical Center.
The study authors suggest that simply focusing on deceased individuals could possibly ignore important associations between consumption of resource and mortality. They are of the opinion that acting on variation may perhaps call for a careful balance between trying to decrease resource use and improving health outcomes.
They further claimed that crucial efforts to reduce inefficient use of resources should be protected against unintentional cutbacks of beneficial resources as well.
Evidently, the study was designed in order to further inspect differences among hospitals. More so, this study claims that it is not a comment on the various studies which have examined variations among geographic areas.
However, it seems to emphasize the possible complications of ignoring health outcomes in discussions about reducing health care utilization at hospitals. This study appears to have focused on elderly Medicare beneficiaries hospitalized from 2001 to 2005 for heart failure.
This study is titled as ‘Looking Forward, Looking Back: Assessing Variations in Hospital Resource Use and Outcomes for Elderly Patients With Heart Failure.’ Additionally, the six hospitals included in this study were, UCLA Medical Center which is now called as Ronald Reagan UCLA Medical Center); UC San Francisco Medical Center; Cedars-Sinai Medical Center, Los Angeles; UC San Diego Medical Center, UC Irvine Medical Center and UC Davis Medical Center.
The findings of the study have been published in the journal, Circulation.