A recent journal report affirms the notion that the U.S. provides quality acute care, but also indicates that there's room for improvement in chronic care.
The report, released Nov. 28, compared 30-day and one-year mortality rates between American and Canadian heart-failure patients from 1998 to 2001.
The findings: After risk standardization, the 28,521 U.S. Medicare beneficiaries studied had a lower 30-day mortality rate than the 8,180 similarly aged patients at hospitals in the province of Ontario (8.9% vs. 10.7%).
But one-year adjusted mortality rates were essentially the same (32.2% in the U.S. vs. 32.3% in Canada).
"I think that the paper provides interesting insight, which has both good news and bad news," said Harlan Krumholz, a physician researcher and author of the report and a professor of medicine at the Yale University School of Medicine.
Krumholz said the study reinforces that the "U.S. is quite good at acute care," while "Canadians may be doing better at managing chronic care."
What's puzzling, Krumholz said, is that healthcare professionals in both nations are exposed to essentially the same medical literature and have comparable training. So the differences in outcomes, Krumholz said, are probably the result of the context in which care is delivered and the way healthcare systems are configured.
The Archives of Internal Medicine report noted that similar findings were discovered with heart-attack and post-surgical patients, and "may reflect better access in Canada to outpatient follow-up and prescription drugs, which are universally covered in the Canadian healthcare system."
Patients considered "ideal candidates" for beta blockers received prescriptions at discharge 32.5% of the time in the U.S., and 29.7% of the time in Canada. For angiotensin-converting enzyme, or ACE, inhibitors, ideal candidates received them at discharge 78.3% of the time in the U.S., compared with 77.6 % in Canada.
The report also noted that those are areas that could be easily improved. "In both countries, a considerable number of elderly patients were prescribed neither therapy despite the proven benefits, suggesting an opportunity to improve the care of (heart failure) patients regardless of where they are treated," according to the report.
Krumholz said he didn't believe current quality-improvement efforts, which have been gaining traction since the years covered in the study, would alter the findings significantly. What he thought may change patient outcomes, however, was the new Medicare prescription-drug benefit.
"It's not a perfect benefit, but it will be interesting to see if these findings will be different," he said, adding that "Quality measures for heart failure are rather meager."
The study was a collaboration between U.S. and Canadian researchers, and Krumholz described the project as an opportunity to "take advantage of the natural experiment that occurs across the borders" and said that the possibility of further collaboration was still under discussion.