More hospital spending tied to lower mortality, readmissions

It's not exactly the news hospitals that are strapped for cash want to hear. A new study in The Journal of the American Medical Association (JAMA) found that Canadian hospitals that spent more on patient care had lower mortality rates and fewer readmissions.

Researchers from the Institute for Clinical Evaluative Sciences in Toronto looked at adult patients admitted to Ontario hospitals between 1998 and 2008 for heart attack, congestive heart failure, hip fracture and colon cancer, according to U.S. News & World Report's HealthDay. They found that the highest-spending hospitals had a 30-day mortality rate for congestive heart failure of 10.2 percent, compared to 12.4 percent at the lowest-spending hospitals. And the readmission rate for colon cancer patients at hospitals that spent more was 10.3 percent, compared to 13.1 percent at low-spending hospitals.

But it might not be fair to compare spending and outcomes between Canada and the United States. Research in the States has shown the approach of higher spending doesn't guarantee better outcomes, Bloomberg reported.

Study authors noted that, comparatively, the United States has a three to four times higher per-capita supply of specialized technology, such as computed tomography and magnetic resonance imaging scanners, but the two countries share similar supplies of hospital beds and nurses. The difference may be the way the money is spent.

"When we spend more, and when we place these specialized resources, we're doing it in an efficient way," study author Therese Stukel, a senior scientist at the Institute for Clinical Evaluative Sciences in Toronto, told Bloomberg. "That's in contrast to the U.S."

Researchers also noted that the most expensive hospitals were often academic hospitals or community hospitals with more specialty physicians; they also had more resources, such as cancer centers, cardiac surgery and diagnostic imaging facilities.

"It would be facile to interpret this study as demonstrating that higher spending is causally related to better outcomes and that providing more money to lower-spending hospitals would necessarily improve their outcomes," the study authors wrote. "Higher-spending hospitals differed in many ways, such as greater use of evidence-based care, skilled nursing and critical care staff, more intensive inpatient specialist services, and high technology, all of which are more expensive."

Still, the Canadian study might provide some insight into how finances are used to lower readmissions and mortality.

"Sometimes it just costs more money to have better outcomes," David Goodman, co-principal investigator at the Dartmouth Atlas, told Bloomberg.

For more information:
- check out the JAMA study
- read the Bloomberg article
- read the U.S. News & World Report article

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