Higher Spending by Hospitals Improves Outcomes

Lower mortality, readmission for acute patients admitted to hospital in highest tercile of spending

TUESDAY, March 13 (HealthDay News) -- Hospitals that are part of the universal health care system in Canada that spend more on inpatient care have lower rates of deaths and hospital readmissions, according to a study published in the March 14 issue of the Journal of the American Medical Association.

To investigate mortality and readmissions among acute care patients admitted to higher spending hospitals, Therese A. Stukel, Ph.D., of the Institute for Clinical Evaluative Sciences in Toronto, and colleagues assessed data on adults (>18 years) with a first admission for acute myocardial infarction (AMI; 179,139 patients), congestive heart failure (CHF; 92,377 patients), hip fracture (90,046 patients), or colon cancer (26,195 patients). Hospital, physician, and emergency department services were included as part of the hospitals' end-of-life expenditure index.

The researchers observed lower rates of all adverse outcomes for patients admitted to hospitals in the highest versus lowest spending intensity terciles. In the highest versus the lowest spending hospitals, the age- and sex-adjusted 30-day mortality rates, respectively, were 12.7 and 12.8 percent for AMI, 10.2 and 12.4 percent for CHF, 7.7 and 9.7 percent for hip fracture, and 3.3 and 3.9 percent for colon cancer. The fully adjusted relative 30-day mortality rates for AMI, CHF, hip fracture, and colon cancer were 0.93, 0.81, 0.74, and 0.78, respectively. Similar results were seen for one-year mortality, readmissions, and major cardiac events.

"Among Ontario hospitals, higher spending intensity was associated with lower mortality, readmissions, and cardiac event rates," the authors write.

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