For the second year in a row, a study identifying the top orthopedic hospitals found that volume correlates with quality.
Those hospitals making the "Top 100" list for orthopedics did more procedures and had lower complications and length of stay compared with hospitals in a broader peer group.
The premier 100 orthopedic hospitals, as identified by HCIA-Sachs, an Evanston, Ill.-based healthcare information company, had 59% more orthopedic patients than did their peers and a 31% lower complication rate for orthopedic procedures.
"There is a significant variance in treatment outcomes in this country despite the fact that there was been so much focus on orthopedics," said Jean Chenoweth, executive director of the HCIA-Sachs Institute, the research and education division of the parent company.
The study also said that if all hospitals providing orthopedic services performed at the level of the Top 100, or benchmark group, length of stay nationwide would drop by 4.6% and costs would fall more than 3%.
The Top 100 list is divided into three subcategories: teaching hospitals with orthopedic programs, teaching hospitals without orthopedic residency programs and nonteaching hospitals. Only 13 hospitals that made the inaugural HCIA top 100 orthopedic hospitals list, published last November, were also on this year's tally (Nov. 22, 1999, p. 34). Chenoweth attributed the low repeat rate to changes made in the study methodology in the past year.
The data show that teaching hospitals stand out when it comes to discharging people home as opposed to an institutional setting, such as a skilled-nursing facility. Teaching hospitals with orthopedic residencies and teaching hospitals without orthopedic residencies in the benchmark group sent 56.5% and 54.1% of their patients home, respectively.
Nonteaching hospitals in the benchmark group discharged 49.7% of their patients home, bypassing an institutional step-down unit.
The study also revealed that nearly half of male patients were discharged home while only a third of the women were sent home before being transferred to a step-down unit.
The study was based on 1999 Medicare data. Hospitals were included in the Top 100 list based on their aggregate score across six measures: mortality, complications, volume, average length of stay, cost per patient, and percentage of patients discharged home.
Editors note: The complete Top 100 orthopedic hospital list can be found at www.modernhealthcare.com.