COMPARING OUTCOMES AND CHARGES FOR PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION IN 3 COMMUNITY HOSPITALS - AN APPROACH FOR ASSESSING VALUE

Objective: To assess the value of care (i.e. outcomes in relation to c harges) for acute myocardial infarction (Acute MI) patients in three c ommunity hospitals after controlling for patient mix differences. Desi gn: An observational study of a cohort of acute MI patients admitted t o hospital for care were studied based on medical record review and on patient-completed questionnaires at 8 weeks post-discharge. Setting: Three community hospitals located in urban areas in the southeastern r egion of the United States. Patients: A consecutive sample of 133 non- transfer Acute MI patients were entered into the study based on EKG re sults, enzyme tests and chest pain characteristics. Hospital medical r ecord and charge data were available on all patients and patient-repor ts on 86% of survivors. Main outcome measures: Data were gathered on c linical outcomes (death, angina, dyspnea), functional outcomes (physic al and psychosocial), satisfaction, and resource intensity (length of stay, total hospital charges, ancillary charges), Because of patient m ix differences across hospitals, outcomes were adjusted for severity o f Acute MI, comorbidity and demographics. Results: There were importan t patient mix differences across hospitals, For example, Hospital C ha d more comorbidity than Hospital B (57.78% of Hospital C patients vs 1 5.00% of Hospital B patients were rated moderate or severe using a wel l tested index, p < 0.0001), After adjusting for patient mix differenc es, Hospital C scored significantly better on four of six outcome meas ures (i.e. angina, dyspnea, physical functioning, psychosocial functio ning). For example, Hospital C's patients' mean scores on physical fun ctioning at 8 week follow-up averaged 75.19 (on a 0-100 scale), while Hospital A's was 63.03 and Hospital B's was 48.57 (F-ratio = 4.95; p < 0.05). However, Hospital A scored significantly lower on all three re source intensity indicators (length of stay, ancillary charges, and to tal charges), For example, Hospital A's ancillary charges averaged $10 ,752 while Hospital B's and C's averaged $11,432 and $16,598 respectiv ely. Between-hospital comparisons on adjusted mortality and satisfacti on did not differ significantly. Conclusion: The ''value'' profiles (i .e. outcomes related to charges) produced by these three hospitals wer e substantially different. Studies that simultaneously measure outcome s, costs, patient mix and processes have potential to: (a) enable clin ical teams to improve the measurable value of clinical care; and (b) e nable purchasers to better evaluate which providers to select as prefe rred sources of care.