Outcomes Discrepancy


A new study in the Journal of Hospital Medicine that reports insured hospitalized patients from ages 18-64 have 50% higher odds of surviving a heart attack or stroke than their uninsured counterparts should be a wake-up call to HM leaders looking to improve standards of care, one hospitalist says.

“It’s almost startling and embarrassing when you see the statistics on paper,” says Danielle Scheurer, MD, MSc, SFHM, assistant professor of medicine at Harvard Medical School and director of Boston-based Brigham and Women’s Hospital’s general medicine service. “If you’re going to assign a specialty to address the problem, it’s a hospital medicine problem.”

The researchers retrospectively analyzed 150,000 discharges among patients hospitalized for acute myocardial infarction (MI), stroke, or pneumonia (DOI: 10.1002/jhm.687). Compared with the privately insured, the study reported "in-hospital mortality among AMI and stroke patients was significantly higher for the uninsured (adjusted odds ratio [OR] 1.52, 95% confidence interval [CI], 1.24-1.85 for AMI and 1.49 OR, 1.29-1.72 for stroke) and among pneumonia patients was significantly higher for Medicaid recipients (1.21 OR, 1.01-1.45)." The lead author was Omar Hasan, MBBS, MPH, an instructor at Harvard Medical School and a hospitalist at Brigham and Women’s.

Dr. Scheurer cautions that the subject raised by her colleague is a multidimensional problem with no easy solution. Physicians may unconsciously make triage decisions that feed into the difference of care, she says, while insured patients who more actively engage their doctors could also skew the numbers.

She thinks, however, that “systematically creating protocols, policies, and procedures” could result in clinical-care delivery that helps reduce the disparity.

“Part of [the importance of the study] is having an open dialogue,” Dr. Scheurer says. “This is real. There is this disparity.”

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