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More Expensive Hospital Care May Not Mean Better

Analysis found costs and quality of hospitalization varied nationally

TUESDAY, Feb. 23 (HealthDay News) -- Hospitals that spend more to treat patients don't necessarily have the best quality of care, researchers say.

In a study that analyzed national data on discharged Medicare patients who'd been hospitalized for congestive heart failure or pneumonia in 2006, researchers at the University of Michigan, Ann Arbor, found wide variation in the costs of care.

The average cost of care for a typical patient with congestive heart failure was $7,114, but ranged from $1,522 to $18,927 among 3,146 hospitals. The average cost of care for a typical patient with pneumonia was $7,040, but ranged from $1,897 to $15,829 among 3,152 hospitals, according to the study findings published in the Feb. 22 issue of the Archives of Internal Medicine.

"Compared with hospitals in the lowest-cost quartile [one-fourth] for congestive heart failure care, hospitals in the highest-cost quartile had higher quality-of-care scores [89.9 percent vs. 85.5 percent] and lower mortality [death] for congestive heart failure [9.8 percent vs. 10.8 percent]," wrote Dr. Lena M. Chen and colleagues. "For pneumonia, the converse was true. Compared with low-cost hospitals, high-cost hospitals had lower quality-of-care scores [85.7 percent vs. 86.6 percent] and higher mortality for pneumonia [11.7 percent vs. 10.9 percent]."

The researchers also found that hospitals with lower costs had similar or slightly higher 30-day readmission rates (24.7 percent for congestive heart failure and 17.9 percent for pneumonia) than higher-cost hospitals (22 percent for congestive heart failure and 17.3 percent for pneumonia).

But the study found that patients initially seen at lower-cost hospitals still had lower overall costs of care over six months than those initially seen at higher-cost hospitals ($12,715 vs. $18,411 for congestive heart failure and $10,143 vs. $15,138 for pneumonia).

"Our findings did not support the hypothesis that hospitals seeking to lower cost of care by discharging patients earlier ultimately use more hospital resources over time," Chen and colleagues wrote. "Although low-cost hospitals had about 20 percent shorter length of stay, their patients had comparable or marginally higher readmission rates and substantially lower six-month total inpatient cost of care. Therefore, our findings suggest that initial lower hospital cost of care may not have a deleterious effect on long-term inpatient use."

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The U.S. Agency for Healthcare Research and Quality offers advice about finding quality health care.

-- Robert Preidt

SOURCE: JAMA/Archives journals, news release, Feb. 22, 2010

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