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Chronically Ill Patients Get More Care, Less Quality, Says Latest Dartmouth Atlas
Date:4/7/2008

guidelines, two factors drive decisions about care:

-- Both doctors and patients generally believe that more services--that is, using every available resource such as specialists, hospital and ICU beds, diagnostic tests, imaging and the like--mean healthier patients.

-- Based on this assumption, it is the supply of beds and treatments and specialists--not how sick people are--that determines how much they get used. The supply of services creates its own demand, so regions with more resources have more usage and thus higher costs.

The wide variations among academic medical centers clearly show the lack of scientific consensus on how to manage chronically ill patients.

Consider this comparison between the Mayo Clinic's flagship St. Mary's Hospital and UCLA Medical Center.

-- Spending: UCLA spent more than $93,000 per patient over the last two years of life. The Mayo Clinic, by contrast, spent $53,432--a little more than half the amount of UCLA on similar patients over the same period of time.

-- Utilization: Chronically ill patients in their last six months of life had more than twice as many physician visits at UCLA compared with Mayo, and they spent almost 50 percent more days in the hospital.

-- Resource Use: Compared to the Mayo Clinic, UCLA uses one-and-a-half times the number of beds, almost twice as many physician FTEs in managing similar patients.

The report says academic medical institutions and federal agencies devoted to health research must begin producing studies on when to hospitalize chronically ill people, how often they should visit a doctor and the like.

The report also found that, contrary to conventional wisdom, adding alternatives to hospitals is not slowing down costs. Spending on hospitalization actually was higher in regions with more alternatives to hospitals--such as rehabilitation hospitals and skilled nursing facilities. Spending for hospice care was the only
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SOURCE Dartmouth Atlas Project
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