Wednesday, March 14, 2012

Gastar més per una qualitat superior

Association of Hospital Spending Intensity With Mortality and Readmission Rates in Ontario Hospitals
Un grup d'investigadors canadencs s'han preguntat si el pacients admesos a hospitals d'aguts més cars reben una qualitat més gran, o més concretament si els reingressos i la mortalitat són menors.
La forma de mesurar els resultats va ser:
The primary outcomes were 30-day and 1-year mortality as well as 30-day and 1-year readmissions, a marker of general complications.16 For cardiac cohorts, we assessed major cardiac events, defined as readmission for AMI, CHF, or angina.17,18​,19 Readmissions were analyzed as a combined outcome with mortality, because the factors causing mortality were likely an exacerbation of those causing readmission so that these events were not independent, making it inappropriate to censor for mortality.
I la troballa, després d'una metodologia fina:
 We found that higher hospital spending intensity was associated with better survival, lower readmission rates, and better quality of care for seriously ill, hospitalized patients in Ontario in a universal health care system with more selective access to medical technology. Higher-spending hospitals were higher-volume teaching or community hospitals with high-volume or specialist attending physicians and having specialized programs, such as regional cancer centers, and specialized services, such as on-site cardiac catheterization, cardiac surgery, and diagnostic imaging facilities. The study also points to plausible mechanisms through which higher spending may be associated with better outcomes.
I just després expliquen alguns possibles motius més enllà de gastar més.
 For acute conditions, timely access to preoperative and in-hospital specialist care, skilled nursing staff, rapid response teams, cardiac high-technology services, and regional cancer centers, all found in the higher-spending systems, are related to better outcomes.21​,27,34​,35,36​,37,38​,39 These systems also provided consistently, but not strikingly, higher levels of evidence-based care and collaborative ambulatory care, both shown to improve care.
De fet la pregunta hauria d'haver estat diferent, sobre els factors determinants de la mortalitat i els reingressos als hospitals, i després identificar la variable despesa, modular-la segons servei ajustat per risc. Així és com crec que hauria tingut més sentit. Però el titular no hauria estat tant cridaner i hauria passat per alt.

PS. El dilluns passat el patí de vela va ser el protagonista de l'espai terra a TV3. Ho podeu veure a partir del minut 7. Tal com diuen, qui ho ha provat ja no ho deixa mai.

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