More aggressive hospital care does not lead to improved patient outcomes in all cases, study finds

May 30 2008

More aggressive hospital care -- such as higher numbers of tests and procedures and longer stays -- does not lead to improved patient outcomes in all cases, according to a study released on Thursday, the Seattle Post-Intelligencer reports.

The 2008 Dartmouth Atlas of Health Care study, conducted by Dartmouth College researchers as part of the Dartmouth Atlas Project, examined the records of more than four million Medicare beneficiaries who between 2001 and 2005 received care at an estimated 3,000 hospitals nationwide during the last two years of their lives. Study participants received treatment for nine medical conditions -- congestive heart failure, chronic pulmonary disease, cancer, dementia, coronary artery disease, chronic kidney failure, peripheral vascular disease, diabetes with organ damage and severe chronic liver disease.

The study found that participants who underwent higher numbers of tests and procedures and stayed in the hospital longer had increased risk for medical errors and complications and cost more to treat. In addition, the study found that participants received different intensity of care based on where they lived and from which hospitals they received treatment (Black, Seattle Post-Intelligencer, 5/30). According to the study, hospitals in New York, Los Angeles and Miami provided the most aggressive care (Ostrom, Seattle Times, 5/29).

Study co-author David Goodman said, "The general principle is that greater intensity of care is not better, and at the high end can actually be harmful" (Hartocollis/Fessenden, New York Times, 5/30).

Online Service

In conjunction with the study, Consumers Union launched a new online service that will rate an estimated 3,000 hospitals nationwide based on the intensity of care provided for the nine medical conditions. The service will allow users to view graphs that rate the intensity of care based on a scale of zero for the most conservative treatment to 100 for the most aggressive treatment. In addition, the service will include information on out-of-pocket costs for Medicare beneficiaries at the hospitals.

John Santa, director of the Consumer Reports Health Rating Center, said, "When (patients are) in hospitals longer, the longer exposure can lead to hospital-acquired disease; more doctors involved in care can lead to communication problems." He said, "A major reason for more aggressive care is more hospital beds, more MRI machines, more doctors," adding, In order to 'compete' and survive economically, those hospitals and doctors need to do more stuff" (Colliver, San Francisco Chronicle, 5/30).

The study is available online.