GOVERNMENTHospital care varies widely for chronically ill Medicare patientsDartmouth Medical School studies show the need for disease management and pay-for-performance programs, CMS chief says.By David Glendinning, amednews staff. Nov. 1, 2004. Washington -- Striking differences exist in the level and quality of care for chronically ill Medicare patients among some of the top U.S. hospitals and academic medical centers, according to two recently released Dartmouth Medical School studies. The studies, conducted by researchers John Wennberg, MD, MPH, and Elliott Fisher, MD, MPH, utilize fee-for-service Medicare claims data. Medicare beneficiaries with chronic illness who sought care in their last six months of life at Mount Sinai Medical Center in New York, for instance, spent nearly twice as many days in the hospital as those who went to a Mayo Clinic facility in Rochester, Minn., Dr. Wennberg said. U.S. News and World Report ranked Mount Sinai the third best geriatric hospital and Mayo Clinic the sixth best in 2001, a period covered by the first of the two Dartmouth studies, both of which were published online Oct. 7 by the journal Health Affairs. In terms of physician visits, chronic care seniors at first-ranked University of California at Los Angeles Medical Center experienced twice as many as those who went to fourth-ranked Duke University Medical Center in Durham, N.C., Dr. Wennberg reported. Dr. Fisher's companion study, which, like the other report, adjusts for severity of illness, suggests that such increased use of hospital admittance and physician visits is not necessarily a good thing for geriatric patients, at least when it comes to those in the nation's nearly 300 academic medical centers. His investigation into initial hospitalizations of Medicare heart attack and colorectal cancer patients finds that the seniors exhibited a small but "statistically significant" increase in long-term mortality rates at the higher-intensity facilities. [...]Full text of American Medical News content is available to AMA members and paid subscribers.
Copyright 2004 American Medical Association. All rights reserved.
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