Navigation Links
Hospital outcomes research named 'Article of the Year'

Health services researchers who studied controversial aspects of Medicare spending and quality of patient care received a prestigious award yesterday from the nation's largest health services research professional association.

The organization, AcademyHealth, presented its 2011 Article of the Year Award to Jeffrey H. Silber, M.D., Ph.D., director of the Center for Outcomes Research at The Children's Hospital of Philadelphia, and his collaborator, Robert Kaestner, Ph.D., of the University of Illinois at Chicago. The award presentation occurred yesterday at AcademyHealth's Annual Research Meeting in Seattle.

The Article of the Year Award recognized two companion studies by Silber and Kaestner: "Aggressive Treatment Style and Surgical Outcomes," published in the December 2010 issue of the journal Health Services Research, and "Evidence on the Efficacy of Inpatient Spending on Medicare Patients," published the same month in The Milbank Quarterly.

As an indicator of aggressive care, Silber and Kaestner used the Dartmouth Index, a prominent set of measures of inpatient spending on elderly patients. In studying over 5 million Medicare admissions for various surgeries between 2000 and 2005, they found that surgical patients in hospitals with a more aggressive treatment style were less likely to die within 30 days of admission compared to patients in less aggressive hospitals. They also found that this benefit was stable, persisting after the 30-day mark.

Silber, who is a senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania, said that these findings contradicted cost-cutting arguments made by those who assert that patients would not be harmed by reductions in Medicare spending. "People have recently argued that more spending does not yield gains in quality of care," said Silber. "Our study suggests that such a belief may be incorrect, and that cutting spending through reductions in aggressiveness may lead to worse outcomes. We should not kid ourselves that the process of reducing Medicare expenditure will be a painless one."

Much of the high cost associated with surgery is the result of complications. "We studied whether more aggressive measures lead to more complications, and found there was no difference in complication rates between aggressive and less-aggressive hospitals," said Silber, adding, "However, when complications arise, patients are more likely to survive those complications if they receive aggressive treatment."

The survival rates after 30 days were important, said Silber. After that period, patients at both aggressive and less aggressive hospitals had equal survival rates one year after admission; there was just a greater initial chance of surviving at the more aggressive hospitals. "It appears," said Silber, "that the survival benefits gained at aggressive hospitals are as stable as in patients who survive at less aggressive ones, suggesting that the life saved at more aggressive hospitals is not more fragile or fleeting than a survivor in the less aggressive hospital."

The journal articles attracted some press attention earlier this year when they were described in February online articles in the New York Times. At the time, Silber said, "Most people have been saying that the health care system is too aggressive, implying that aggressiveness is bad because people are being operated on unnecessarilyBut we have to do detailed research that compares the effectiveness of different treatment approaches, because aggressiveness is not necessarily bad and may in fact be sometimes associated with better outcomes."

Ultimately, concluded Silber, his research shows that cost-cutting in health care must be done carefully and based on evidence: "It matters how we cut expenditures, because although some spending may be inefficient, our results suggest that the amount of waste is less than conventionally believed, at least for inpatient care."


Contact: John Ascenzi
Children's Hospital of Philadelphia

Related medicine news :

1. Reducing avoidable rehospitalizations among seniors
2. Hypnosis/local anesthesia combination during surgery helps patients, reduces hospital stays
3. New hospital mortality rate index to be used across UK
4. Pioneering hospital pay-for-performance program falls short of its goals
5. Joint Replacement Risks Rise at Less Experienced Hospitals
6. Rhode Island Hospital fellow receives funding to support research in myocardial perfusion
7. Joint replacement surgery riskier at hospitals with low surgical volume
8. Not all hospitals treat elderly the same
9. Emergency Care May Be Key to Hospital Readmissions
10. Re-admission rates via emergency rooms climbing among patients who have recently been hospitalized
11. Hospital Visitors Cellphones May Carry Worrisome Germs
Post Your Comments:
(Date:11/25/2015)... ... ... Students and parents have something to be thankful for this Thanksgiving week ... California Casualty is proud to support the contest designed to utilize peer-to-peer ... the number one killer of young drivers. , Almost 1,000 entries of original ...
(Date:11/24/2015)... ... , ... New patients who wish to seek treatment for missing teeth can ... her Mississauga, ON practice. Dr. Williams has been providing dental service for over 34 ... Missing teeth can lead to a variety of complications if they are not replaced ...
(Date:11/24/2015)... ... 2015 , ... Catalent Pharma Solutions, the leading global provider ... global clinical supply services, today announced that Dr. Christine Milligan, Global Director, Strategic ... to be held at the InterContinental Seoul COEX Hotel, Seoul, Republic of Korea, ...
(Date:11/24/2015)... Boston, MA (PRWEB) , ... November 24, 2015 ... ... today announced that the organization will waive paid entry and parking fees at ... in Hingham, and Monument Mountain in Great Barrington in support of REI’s Black ...
(Date:11/24/2015)... ... November 24, 2015 , ... ... United States to support their local poison centers through donations on Tuesday, Dec. ... calls it “a day that inspires people to collaborate in improving their ...
Breaking Medicine News(10 mins):
(Date:11/24/2015)... LAUSANNE and BERN, Switzerland ... SA, the ARTORG Center for Biomedical Engineering Research of ... and the Division of Endocrinology, Diabetes and Clinical Nutrition ... announce the start of an exclusive collaboration to develop ... control algorithm for the personalised delivery of insulin for ...
(Date:11/24/2015)... , November 24, 2015 st  Scientific ... North America (RSNA) taking place in Chicago ... Booth 1122, Hall A. --> st  Scientific Assembly and ... (RSNA) taking place in Chicago ... Hall A. --> Molecular Dynamics will present its revolutionary ...
(Date:11/24/2015)... , November 24, 2015 The uptake of ... will be a key driver of market growth to 2021, ... recently approved and pipeline premium products for Type 1 Diabetes Mellitus (T1DM), ... says GBI Research . --> The uptake ... (T1DM), will be a key driver of market growth to 2021, ...
Breaking Medicine Technology: