Researchers set out to show that giving sick people better access to family doctors keeps them out of the hospital. But to the surprise of everyone involved, the study found just the opposite.
Doctors apparently end up diagnosing more ills, including ones that probably would otherwise go unnoticed.
"I went in knowing that primary care could help keep these patients out of the hospital. That was my passion. I was exactly wrong," said Eugene Z. Oddone, M.D., of the Veterans Affairs hospital in Durham, N.C.
He and Morris Weinberger of the VA hospital in Indianapolis had thought the experiment would prove the obvious: Better primary care keeps people healthier, reducing hospital admissions by about one-third and saving money.
Working with nine VA hospitals, they offered poor, seriously ill veterans the kind of care available in most HMOs-ready access to a nurse, a family doctor in charge of their case, reminders of appointments and follow-up phone calls.
After six months of this attention, hospitalizations actually rose by one-third.
The researchers said their study, published in the May 30 issue of the New England Journal of Medicine, illustrates one of the difficulties of refashioning the healthcare system: Even common-sense ideas need to be tested to make sure they work.
Furthermore, for some it raises doubts about an article of faith among doctors-that catching and treating diseases early will make people healthier in the long run.
The VA researchers noted that their patients were already seriously ill, so their ailments were probably not being diagnosed early.
They also denied the assertion that the experiment might have been harmful. Even though there were 25% more deaths among the patients getting the extra attention, they said the difference was not statistically meaningful.
The researchers said the extra care obviously resulted in higher medical bills, but they have not yet calculated how much.
The study involved 1,396 veterans-most of them men, most of them severely ill-who had been hospitalized for treatment of diabetes, congestive heart failure or chronic obstructive lung disease.