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Revascularization Outcomes at Specialty vs. General Hospitals

As more specialty hospitals sprout up, are Medicare patients who undergo coronary revascularization faring better at these hospitals than at general hospitals?

Do specialty hospitals that emphasize specific procedures provide higher-quality care than general hospitals do? To find out, researchers retrospectively compared outcomes among 42,737 Medicare patients who underwent percutaneous coronary intervention (PCI) and 26,274 who underwent coronary artery bypass grafting (CABG) at 15 specialty and 82 general hospitals in the same geographic region.

Compared with general hospitals, specialty hospitals performed significantly more PCI and CABG procedures and treated patients with higher incomes and housing values (according to ZIP code data). The predicted risk for death after PCI was significantly lower at specialty hospitals than at general hospitals (2.1% vs. 3.1%), as was the predicted risk for death after CABG (5.0% vs. 5.8%). The actual unadjusted mortality rates were in line with those predictions (PCI: 2.1% vs. 3.2%; CABG: 4.7% vs. 6.0%).

However, after adjustment for patient characteristics, the specialty hospitals' mortality advantage became nonsignificant for PCI (odds ratio, 0.89; P=0.39) and barely remained significant for CABG (OR, 0.84; P=0.05). After further adjustment for hospital procedural volumes, the specialty hospitals no longer had any advantage for PCI (OR, 1.05; P=0.68) or CABG (OR, 0.91; P=0.35). In the adjusted analysis, length of hospital stay did not differ significantly at specialty versus at general hospitals.

Comment: In this observational study, Medicare patients who underwent coronary revascularization procedures at specialty hospitals had no outcome advantage over those treated at general hospitals, after adjustment for patient characteristics and hospital procedural volumes. The data also suggest that, on average, specialty hospitals care for healthier and wealthier patients. The study did not address the potential consequences for nearby general hospitals when their volumes are lowered.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology May 13, 2005

Citation(s):

Cram P et al. Cardiac revascularization in specialty and general hospitals. N Engl J Med 2005 Apr 7; 352:1454-62.

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