Expensive hospital care may not save more lives

NEW YORK Mon Feb 28, 2011 5:35pm EST

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NEW YORK (Reuters Health) - Hospitals that spend the most on their very sickest patients don't always see a benefit from the extra spending, a new study shows.

"We expected to see a lot of variations in costs and outcomes, and we did," said Dr. Tara Lagu from Baystate Medical Center in Springfield, Massachusetts, who headed the research, in an interview with Reuters Health.

Her study looked at how much money 309 U.S. hospitals spent to care for patients with a life-threatening illness called sepsis in which the immune system responds so dramatically to infection that a number of organs start to fail. Patients with sepsis usually need highly sophisticated - and expensive - treatments such as breathing machines.

The researchers found that some hospitals spent less than the others, and yet saved more patients.

"There's no reason for an a priori statement that the more you spend, the better you do" for sepsis patients, Dr. John Marshall, a critical care surgeon at St. Michael's Hospital in Toronto and sepsis researcher who was not involved in the current study, told Reuters Health.

Altogether, Lagu and her colleagues had information on close to 167,000 patients with sepsis. They knew how old these patients were, what other diseases they had, and other facts about them that might affect their chances of survival.

The researchers first looked at deaths and costs separately. Rates of death varied from roughly 1 in 10 to 1 in 3, they report in the Archives of Internal Medicine. Average costs per patient ranged from roughly $12,000 to $37,000.

"When examining costs and (deaths) concurrently, 22 hospitals had both significantly lower than expected costs and lower than expected mortality rates, and 30 hospitals had both higher than expected costs and mortality rates," the authors say.

No outward features distinguished the higher value hospitals from the lower value ones, Lagu told Reuters Health - not, for example, their size, nor whether they were attached to universities with medical schools, nor their location in rural or urban areas.

It was unclear why some hospitals did better than others. Other research has suggested that sepsis patients do better when certain treatments are "bundled" together - and the current study couldn't tell if that was case at these hospitals.

Marshall said that Lagu's patients included more women than he'd expect to see in a group of people with sepsis. There were also more elderly people, more people with unknown types of infections, and not as many people in intensive care units.

These differences might affect how well the study's results will match the reality at larger numbers of hospitals, he said.

Instead, Lagu said, her findings are "a big picture look" that "opens up a lot of work to be done."

"If we can investigate what leads to high value care, that will help us accomplish some of the goals of the health care reform bill," she said.

At this point she does not recommend linking hospitals' pay to their performance in sepsis care.

"Before we send out letters telling hospitals they need to improve their performance, first let's understand what some hospitals are doing to get better outcomes" and pass that information on to all the others, she said.

SOURCE: bit.ly/hshlAV Archives of Internal Medicine, online February 28, 2011.

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