Previous studies have suggested that academic medical centers are the best choice quality-wise for patients over age 65 and for those needing tertiary care such as major cardiac surgery, but a new study says that younger patients may get the same quality of secondary care at a much lower price from community hospitals. Secondary care refers to lower complexity procedures, such as normal deliveries and orthopedic surgery. Researchers tracked seven inpatient complications, including mortality, for secondary care at community and teaching hospitals in six states. In three of the outcomes -- mortality, wound infection and urinary tract infection -- community hospitals outperformed teaching hospitals. Teaching hospitals had better results for two outcomes, pneumonia after major surgery and pulmonary compromise after surgery. There was no difference between the two types of hospitals in rates of post-surgical mechanical complications and other adverse events. All the complications were rare events for secondary care, generally occurring in less than four-tenths of 1% of cases. Data was adjusted for severity and other patient variables.
Meanwhile, inpatient costs per case at academic medical centers were 19% higher than at community hospitals, the study said. The study was commissioned by the Pioneer Institute for Public Policy Research, Boston. Researchers concluded that academic medical centers could lose much of the under-65, privately insured, secondary-care market if consumer-driven health plans grow in popularity and if consumers respond to the financial incentives in such plans. Read the study. -- by Tony Fong