Specialty Cardiac Hospitals Treat Less Severely Ill Patients Than Non-Specialty Hospitals

EVANSTON, Ill., July 12 -- Patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) at specialty cardiac hospitals are less severely ill than patients who have these surgeries performed at non-specialty hospitals in the same communities, according to research by Solucient, the nation’s leading source of healthcare information products.

The research was published as a Letter to the Editor in the June 30 issue of the New England Journal of Medicine (NEJM).

PCI and CABG are two of the most commonly performed procedures for treating cardiac disease. According to the American Heart Association, cardiac disease affects more than 64 million Americans and continues to be the leading cause of death for men and women in the United States.

Janet K. Young, M.D., M.H.S.A; David Foster, Ph.D., M.P.H; and Sivana T. Heller, M.D., M.P.H. - all of Solucient - looked at whether findings published in the April 7 issue of NEJM by Peter Cram, M.D., M.B.A., of the University of Iowa Carver College of Medicine and colleagues, indicating that mortality rates adjusted for patient characteristics and volume of procedures for Medicare patients undergoing PCI and CABG were similar at specialty hospitals compared to non-specialty hospitals could be generalized to include an all-payer population of patients.

The Solucient researchers used data from January 2002 through September 2004 from Solucient’s all-payer Projected Inpatient Database, which contains information on more than 17 million discharges in the United States annually and has been previously used to analyze trends among patients with cardiac disease.

The researchers analyzed data from 4,123 patients undergoing PCI at specialty hospitals and 13,248 patients undergoing PCI at non-specialty hospitals in the same communities, and 1,680 patients undergoing CABG surgery at specialty hospitals and 6,155 patients having CABG surgery at non-specialty hospitals in the same communities.

They found that the observed (or unadjusted) mortality rates for patients undergoing PCI were about twice as high at non- specialty hospitals compared to specialty cardiac hospitals. However, when the researchers adjusted for patient characteristics, including severity of illness, age, sex, related diagnoses, and volume of procedures performed they found that the mortality rates for patients at specialty and non-specialty hospitals were similar.

The researchers also found that length of stay (LOS) was 37 percent longer for patients undergoing PCI at non-specialty hospitals compared to specialty hospitals, and it was 14 percent longer for patients undergoing CABG surgery at non-specialty hospitals compared to specialty hospitals. When the researchers adjusted for patient characteristics, the LOS at both kinds of hospitals was similar.

“The difference between observed and adjusted outcomes strongly implies that specialty hospitals are treating less severely ill patients than the non-specialty hospitals,” says Dr. Young. “Based on our analysis, we would expect that the mortality rates for PCI and CABG at specialty and non-specialty hospitals would be similar if they treated patients with the same severity of illness.”

“One common way to evaluate efficiency is to look at length of stay,” says Kaveh Safavi, M.D., chief medical officer at Solucient. “The apparent difference in length of stay between cardiac specialty hospitals and non-specialty hospitals for PCI and CABG is greatly diminished after adjusting for severity.”

“We did not study other outcomes or efficiencies that may be present in specialty hospitals,” adds Safavi.

About Solucient

Solucient(r) is an information products company serving the healthcare industry. It is the market leader in providing tools and vital insights that healthcare managers use to improve the performance of their organizations.

By integrating, standardizing and enhancing healthcare information, Solucient provides comparative measurements of cost, quality and market performance. Solucient’s expertise and proven solutions enable providers, payers and pharmaceutical companies to drive business growth, manage costs and deliver high quality care. For more information, visit http://www.solucient.com.

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