Dartmouth prepared the report to help educate medical students about the styles of care — or “hidden training curriculum” — among academic medical centers rated by U.S. News and World Report as the best for clinical excellence in 2012 through 2013. The report examined three categories: care provided in the last six months of life, preference-sensitive care and inconsistency in treatment, and quality care indicators submitted by each hospital to HHS.
“The report demonstrates that hospitals providing higher intensity care are not necessarily providing higher quality or better patient experiences,” according to the report. Authors recommend students examine hospitals’ quality indicators and care cultures when making decisions about their residency, opposed to a hospital’s prestige or reputation.
Care provided in the last six months of life
Teaching hospitals varied in their culture around end-of-life care. The report ranked hospitals with the Hospital Care Intensity index, which combines the number of days patient spent in the hospital and the average number of inpatient physician visits during the last two years of life.
The national average CTI index score is 1.00. Cedars-Sinai Medical Center in Los Angeles scored the highest at 2.06 while Scott & White Memorial Hospital in Temple, Texas, and University of Utah Health Care in Salt Lake City each recorded 0.62. The report also analyzed physician visits in patients’ last six months of life. Cedars-Sinai clocked in at an average 72.6 visits in that time, while UUHC recorded 19.7 — below the state average of 33.7.
Variation in surgical procedures
“Patients’ chances of having prostate surgery, coronary artery bypass grafting or vascular surgery depend as much on where they live as the medical problem that brought them to the physician,” according to the report. The report analyzed rates for 19 hospital service areas associated with the 23 teaching hospitals, revealing practice styles that influence residents’ training.
The incidence of lower extremity bypass in Baltimore was five times greater than that in Temple, Texas. The incidence of radical prostatectomy in Salt Lake City was more than three times that in San Francisco. The incidence rate of back surgery in Nashville, Tenn., was more than double that of Boston. These findings show “a lack of concrete evidence or unsettled debate about the efficacy of the treatment,” according to the report.
Quality care indicators
Although academic medical centers generally offer high-quality care, the report suggests there is still room for improvement. “Medical students should look carefully at these care measures; one cannot assume that either reputation or greater intensity of care ensures better care,” according to the report. The percentage of people who gave their hospital a “high” patient satisfaction rating was more than the national average (68 percent) for 20 of the 23 hospitals analyzed.
Some hospitals, however, had patient safety scores that were worse than the national average. UUHC’s 0.77 score for “falls and injuries” and University of Pittsburgh Medical Center’s 0.74 score exceeded the national average of 0.53. Ronald Reagan UCLA Medical Center in Los Angeles had a 0.71 score for “severe pressure scores”— more than six times the national average of 0.14.
More Articles on Teaching Hospitals:
36 Statistics on Average Hospital All-Payor Margins by Teaching Status
6 Elements of a True Patient Safety Culture
Study: More Expensive Care May Be Better
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