From Our 2012 Archives

Higher Spending Tied to Better Outcomes in Ontario Hospitals

TUESDAY, March 13 (HealthDay News) -- Higher spending hospitals in Canada's universal care health system have lower rates of patient deaths and readmissions, and provide a better quality of care for severely ill patients, according to a new study.

Previous studies that examined the link between hospital spending and quality of care in the United States and other countries produced conflicting results, and the effects of higher spending by hospitals in a universal health care system were unknown, according to Therese Stukel, of the Institute for Clinical Evaluative Sciences in Toronto, and colleagues.

For the new study, Stukel's team examined data on patients older than age 18 who were admitted to hospitals in the province of Ontario between 1998 and 2008 for treatment of heart attack, congestive heart failure, hip fracture or colon cancer.

In the highest- and lowest-spending hospitals, respectively, the 30-day death rate among patients was 12.7 percent vs. 12.8 percent for heart attack, 10.2 percent vs. 12.4 percent for congestive heart failure, 7.7 percent vs. 9.7 percent for hip fracture, and 3.3 percent vs. 3.9 percent for colon cancer.

In addition, the 30-day rate for major cardiac events was 17.4 percent vs. 18.7 percent for patients with heart attack and 15 percent vs. 17.6 percent for those with congestive heart failure at the highest- and lowest-spending hospitals, respectively.

The 30-day readmission rate was 23.1 percent vs. 25.8 percent for patients with hip fracture and 10.3 percent vs. 13.1 percent for those with colon cancer, the investigators found.

Results for death rates, readmissions and major cardiac events after one year were similar, according to the research in the March 14 issue of the Journal of the American Medical Association.

The study authors reported that certain factors were noted among higher-spending hospitals, including that they tended to be higher-volume teaching or community hospitals; located in cities; affiliated with regional cancer centers; and able to provide specialized services. In addition, these facilities were more likely to have higher nursing staff ratios, and admitted patients had longer stays, were less likely to be placed in intensive care and had more specialist visits.

Compared to Ontario, the United States has a three to four times higher supply of specialized medical technology, such as CT and MRI scanners, per person, but a similar supply of acute care beds and nurses, the researchers noted in a journal news release.

"Ontario's 2001 population rates of cardiac testing and revascularization lagged behind corresponding 1992 U.S. rates and paralleled the supply of cardiologists and catheterization facilities," the study authors noted in the release.

"It is therefore possible that Canadian hospitals, with fewer specialized resources, selective access to medical technology, and global budgets, are using these resources more efficiently, especially during the inpatient episode for care-sensitive conditions," the authors said. "Canada's health care expenditures per capita are about 57 percent of those in the United States. At this spending level, there might still be a positive association between spending and outcomes."

-- Robert Preidt

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SOURCE: Journal of the American Medical Association, news release, March 13, 2012