More intensive medical care -- even at some of the most reputable hospitals in the nation -- does not necessarily translate into longer life or better health and may in fact leave patients worse off, according to research released yesterday.
Elderly patients with chronic illnesses who stay in the intensive care unit longer, receive more diagnostic tests or are treated by numerous specialists do not fare better than those who receive less intensive care, two studies conducted by Dartmouth Medical School found.
"We know hospitals are dangerous places," said Elliott Fisher, one of the lead authors and co-director of the Veterans Affairs Outcomes Group based in Vermont. "Higher intensity patterns of practice are associated with no better quality and, if anything, worse quality."
Among older patients who were treated for a heart attack or colorectal cancer, there actually "was a small but statistically significant increase in the risk of death as intensity increased," he found.
"It is clear that quality is inversely correlated with the intensity of care and that the better hospitals are using fewer resources and providing fewer hospitalizations and physician visits," said co-author John E. Wennberg, director of Dartmouth's Center for Evaluative Clinical Sciences.
The pair of studies, published in the journal Health Affairs, lend support to a growing movement in health policy circles toward "evidence based medicine" in which doctors adhere to scientifically proven treatments and providers are paid for results rather than procedures.
Insurers and Bush administration officials said they hope to use the data to demand lower-cost care with proven success rates.
"Higher costs don't necessarily mean higher quality," said Mark McClellan, administrator of the federal Centers for Medicare and Medicaid Services, which sets policy for the programs. "We see great opportunities to improve health without spending more money."
Many in the medical profession, however, cautioned that quality measures are subjective, patient preferences influence treatment decisions and the debate over medical spending cannot ignore prices and profits.
The reason the United States spends more on medical care is "not because Americans use so much more health care, but because our prices are higher and because our decentralized, pluralistic system generates extraordinary overhead costs," wrote former Medicare chief Bruce Vladeck in an accompanying article. "Focusing on utilization permits both providers and payers to change the subject away from the more embarrassing discussion of who's getting paid, by whom and how much."
