Study: 'Hidden' training, care variation at teaching hospitals

Despite academic medical centers touting evidence-based medicine, a new study from the Dartmouth Atlas Project found wide variation in practice, including differences in knee replacements and intensity of end-of-life care.

The study aims to inform fourth-year medical students of a "hidden training curriculum" at teaching hospitals as they choose residency programs, Kaiser Health News reported.

Dartmouth Atlas researchers analyzed Medicare data and found that 23 top academic medical centers differ significantly on quality, safety, patient experience and use of surgical procedures.

For example, 49.4 percent of chronically ill patients treated at Baltimore's Johns Hopkins Hospital in 2010 were enrolled in hospice in their last six months of life, versus 23.1 percent of Mount Sinai Medical Center patients in New York City.  

The numbers suggest a Mount Sinai resident may be trained to explore more aggressive treatment, while a Johns Hopkins resident may learn to discuss patient preferences first, according to the study.

"With such drastic variations from one institution to the next, they clearly cannot all be right. Academic medicine needs to address this gap in clinical science," David C. Goodman, coprincipal investigator for the Dartmouth Atlas Project, said today in a statement.

The study also found patients were twice as likely to get knee replacement surgery in Salt Lake City as in Manhattan, suggesting critical variations in surgical training. A resident trained in Salt Lake may learn a treatment style that focuses on surgery, whereas a New York City resident may be trained to recommend physical therapy.

To close the gap in patterns of care, researchers call for "preference-sensitive care" in which patient preferences guide healthcare decisions.

"The only way to ensure the rate is 'right' is for clinicians to fully inform patients about treatment options and to share treatment decisions, through a process known as 'shared decision-making,'" the study states.

For more:
- here's the study and announcement (.pdfs)
- read the KHN article