Medical care and costs vary considerably among hospitals widely thought to rank as some of the nation's best, according to researchers at Dartmouth University Medical School. Researchers reviewed data on Medicare patients with chronic conditions treated at the top 77 hospitals in U.S. News & World Report's 2001 ranking and seven teaching hospitals identified by the magazine as providing the best geriatric care. Among the variations: Patients at Mount Sinai Medical Center, New York, had hospital stays almost twice as long as similar patients at the Mayo Clinic's hospital in Rochester, Minn.; and patients at University of California Los Angeles Medical Center had three times as many days in the intensive-care unit as their counterparts at Massachusetts General Hospital, Boston. Facilities that ordered more tests, provided more doctor visits or hospitalized patients for longer periods did not provide higher-quality care, the researchers said. In some instances, high-intensity care for patients with certain terminal conditions may have hastened death.
The researchers, led by John Wennberg, director of the Center for Evaluative Clinical Studies at Dartmouth, also said the studies were the first to show that Medicare data can be used as a measure of quality and to identify better-performing hospitals. The latest studies, released in the journal Health Affairs, build on earlier studies by the center that found wide geographic variations in care. Read the studies. -- by Tony Fong