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October 31, 2012

Study finds wide discrepancies in care at 23 top AMCs

Daily Briefing

A Dartmouth Atlas Project review of care provided at 23 top academic medical centers (AMCs) finds "drastic" variation in the amount and type of care provided to Medicare patients.  

For the report, researchers used Medicare data from 2008 to 2010 and data from HHS's Hospital Compare database to identify variations in the intensity of end-of-life care, chronic illness management, surgical procedures, patient experiences, and overall care quality.

Researchers found wide discrepancies in the care provided at top ranked AMCs. For example:

  • One Baltimore AMC enrolled 49.4% of its chronically ill patients into hospital care, whereas one New York City AMC enrolled just 23.1%; and
  • 66.6% of chronically ill patients at a New York City AMC saw 10 or more physicians in their last six months of life, compared to just 42.5% at one Texas AMC.

"With such drastic variations from one institution to the next, they clearly cannot all be right,” David Goodman, co-principal investigator for the Dartmouth Atlas Project, said in a release. He adds, “Academic medicine needs to address this gap in clinical science."

The researchers also found broader regional differences. Between 2008 and 2010:

  • The rate of knee-replacement surgery at Salt Lake City AMCs was 11.9 per 1,000 discharges, compared to just 4.5 per 1,000 discharges at Manhattan AMCs; and
  • The rate of radical prostatectomy was 2.5 per 1,000 discharges at Salt Lake City AMCs, compared to just 0.8 per 1,000 discharges in San Francisco.                                        

The report aims to help fourth-year medical students select residency programs. "It shines a light on hospital characteristics that are often invisible but are part of the hidden training curriculum that can affect a lifetime of practice," the authors write.

The Robert Wood Johnson Foundation's John Lumpkin adds, “During their residency training, young physicians learn by observing faculty, making decisions on how aggressively to treat chronically ill patients at the end of life, and whether to recommend surgery when other treatment options exist” (Robeznieks, Modern Healthcare, 10/30 [subscription required]; Gold, “Capsules,” Kaiser Health News, 10/30; Adams, CQ HealthBeat, 10/30 [subscription required]).

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