ORLANDO, Fla. : Academic medical centers in California have responded to the pressures of managed care with greater effectiveness than other hospitals according to results presented today (October 28) at the 1998 Clinical Congress of the American College of Surgeons.
UCSF researchers found mortality rates from complex abdominal procedures were four-fold lower in teaching and research hospitals than other hospitals. In addition, researchers found shorter lengths of stay and reduced costs for these patients. These results counter the perception that academic medical centers are more costly and inefficient.
"We observed improvements in both length of stay and mortality after complex abdominal operations in all California hospitals, but the improvements were much more dramatic in academic medical centers," said Sean Mulvihill, MD, FACS, UCSF professor of surgery and UCSF chief of the division of general surgery at UCSF Stanford Health Care.
Mulvihill and UCSF colleagues studied patient outcomes and treatment costs associated with complex abdominal surgical procedures between 1990-1994, a time when managed care was increasing throughout California. Using the Office of Statewide Health Planning and Development database, researchers compared mortality, hospital length of stay and resource utilization for patients treated in academic medical centers with those treated in other types of hospitals. The database collects information from all hospitals in California and categorizes it by the demographic characteristics of patients, hospital admission an discharge dates, diagnosis, and surgical procedure.
Study findings showed a decline in operative mortality and length of stay during 1990-94 for all hospitals, however the improvement was greater for academic medical centers, such as UCSF Stanford Health Care. By 1994, mortality was four-fold lower in academic medical centers. In addition, researchers found length of stay, which was similar in academic medical centers and community hospitals in 1990, was significantly shorter in academic medical centers (12.8 days) than in community hospitals (15.1 days) at the end of the study period. UCSF researchers also found that patients treated in academic medical centers had fewer complications, as measured by a smaller percentage of patients with hospital stays longer than 20 days. Nineteen percent of patients who had surgery in academic medical centers stayed longer than 20 days while 28 percent stayed longer in other hospitals.
In a comparison of hospital services used by surgery patients such as chest X-rays and blood tests, findings showed academic medical centers used fewer costly tests and procedures. During the study period, use of these resources declined in academic medical centers and increased slightly in community hospitals.
"The data suggests that the academic medical center provides a service within the health care marketplace that is not matched by the average community hospital in terms of the outcomes of care following highly complex abdominal operations," said Mulvihill.
"Not only does the academic medical center accomplish the teaching mission that society needs but this study shows it also delivers care in an efficient manner." he added.
Co-authors of the study are Robert E. Glasgow, MD, UCSF resident in surgery and Jonathan A. Showstack, PhD, MPH, UCSF professor of medicine and health policy, Department of Medicine and Institute for Health Policy Studies.