Canadian Report Finds Higher-Spending Hospitals See Drops in Death Rate, Readmission


U.S. hospitalists could learn a lesson from a new report that shows patients treated at higher-spending hospitals in Ontario, Canada, had associated drops in death rates and readmissions, says one of the study's authors.

Theresa Stukel, PhD, of the Institute for Clinical Evaluative Sciences in Toronto says that while direct comparisons between Canadian and U.S. healthcare delivery systems can be misleading because the U.S. spends more on healthcare, and this study deals with the universal healthcare system in Canada, "one of the important policy lessons is that it's very important to manage one's resources—to think about the fact that more resources may not lead to better care and to think about where to put the next healthcare dollar."

The report, "Association of Hospital Spending Intensity With Mortality and Readmission Rates in Ontario Hospitals," found that in the highest- versus lowest-spending hospitals, respectively, the age- and sex-adjusted relative 30-day mortality rate was 12.7% vs. 12.8% for acute myocardial infarction patients; 10.2% vs. 12.4% for congestive heart failure patients; 7.7% vs. 9.7% for hip fracture cases; and 3.3% vs. 3.9% for colon cancer patients.

And while higher-spending hospitals showed better outcomes, Dr. Stukel says, more money does not correlate directly to better care. She suggests U.S. physicians look for guidance from domestic health systems, such as Kaiser Permanente, Geisenger Health System, and Intermountain Healthcare, which she says outperform the U.S. averages for quality while spending less than the average costs.

The lesson to hospitalists: be careful what you ask for, Dr. Stukel explains. Physicians always want the latest "testing equipment and therapies," she says. "I think there's a point where having access to these resources means you have to use them; otherwise, you can't amortize them. There's a point where physicians think that if they are not doing a service to the patients, they’re not providing better care."

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