Bigger hospitals may treat some conditions better

LOS ANGELES (AP) - People hospitalized with a heart attack, heart failure or pneumonia fare better if they are admitted someplace that treats a lot of those problems, a large study of Medicare patients finds.

Busier hospitals on average tended to have lower rates of death from these three common conditions than smaller hospitals. The risk of death dropped until the number treated reached 610 heart attacks, 500 heart failures and 210 pneumonia cases a year, the study showed. After that point, the number treated didn't change the outcome.

What does this mean for patients?

In an emergency, people should still head to the nearest hospital.

"Experience does matter, but if you're in the middle of a heart attack, you don't choose which hospital you go to," said Dr. Mark Hlatky, a professor of health research and policy at Stanford University, who had no role in the study.

But for people with chronic conditions, there is the opportunity for patients to shop around in advance.

The federal government has an online tool that lets consumers compare hospitals. The Web site lists death rates from common health problems and data on hospital volume and types of treatment. A hospital's performance can be compared to the national average and other facilities.

All those factors - not just how many patients are treated - should be considered, the researchers said.

"Size tends to matter, but there are differences even within large, medium and small hospitals" in their quality of care, said Dr. Harlan Krumholz, a Yale University cardiologist and one of the study's leaders.

The study, published in Thursday's New England Journal of Medicine, analyzed Medicare claims from 2004 through 2006 for three leading causes of hospitalization among the elderly: heart attacks, heart failure and pneumonia.

During that time, about 735,000 people were hospitalized for a heart attack and there were over 1 million hospitalizations each for heart failure and pneumonia. More than 4,000 hospitals were included.

On average, the larger hospitals in the study treated 236 heart attacks, 422 heart failures and 405 pneumonia cases a year. Compared to smaller hospitals, the risk of death within a month of admission was 11 percent lower for heart attacks, 9 percent lower for heart failure and 5 percent lower for pneumonia.

Previous research has found that people who have heart bypass and other surgeries do better in large hospitals than smaller ones. This latest study, sponsored by the federal government and American Federation for Aging Research, was the first large one to look at other common causes of hospitalization.

Dr. Joseph Ross of Mount Sinai School of Medicine in New York, who led the study, said volume alone does not tell the whole story about a hospital's performance.

"The key for patients is that hospital volume is a weak surrogate for discriminating hospital quality of care," he said.


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