Report: Top Academic Medical Centers Have High Variation in Care Practices
Dartmouth Atlas Project (pdf).
The report, "What Kind of Physician Will You Be? Variation in Health Care and Its Importance for Residency Training," explores variation in care among 23 academic medical centers to guide medical residents as they choose teaching hospitals.
The medical centers consist of hospitals that were rated by U.S. News & World Report as the best hospitals for clinical excellence in 2012-13 as well as other notable hospitals. Cleveland Clinic, The Johns Hopkins Hospital in Baltimore, Northwestern Memorial Hospital in Chicago and University of Washington Medical Center in Seattle are among the hospitals featured in the report. Together, the hospitals represent approximately 17 percent of all primary residency slots in 2012.
The authors used 2010 Medicare data and data for surgical procedures 2008 to 2010 for their report.
Examples of variation in care include the following:
• In 2010, nearly half of chronically ill patients treated at The Johns Hopkins Hospital were enrolled in hospice in their last six months of life compared with only 23.1 percent of patients treated at Mount Sinai Medical Center in New York City. The authors suggested a Mount Sinai resident may learn a higher threshold for referral to hospice care, while a Johns Hopkins resident may be better trained in discussing patients' preferences.
• Patients were twice as likely to undergo knee replacement surgery in Salt Lake City as in Manhattan.
• Patients at NYU Langone Medical Center in New York City were 47 times less likely to contract an infection from a urinary catheter than patients at the University of Michigan Health System in Ann Arbor.
The authors wrote that while all 23 academic medical centers have above-average scores on patient experience, patient safety and processes of care and have high-quality care, there is still room for improvement.
David C. Goodman, MD, MS, co-principal investigator for the Dartmouth Atlas Project and director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy & Clinical Practice, said "These findings challenge the assumption that clinical science alone drives medical practice at these prestigious institutions and thus raise a serious issue for academic medicine," according to a news release. "With such drastic variations from one institution to the next, they clearly cannot all be right. Academic medicine needs to address this gap in clinical science."
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