Differences in Treatment of Common Illnesses Limited

There might be no difference in outcomes between community hospitals and academic medical centers in terms of treating common illnesses, the New York Times reports. However, for more serious conditions, such as cardiac problems or cancer, where a patient can go for treatment makes a difference.

For heart surgery, the defining factor in determining outcomes is a surgeon's experience, while for some cancers, the important factor is how many people at a particular facility have that type of cancer, the Times reports.

Peter Lindenauer, an internist and researcher at Baystate Medical Center in Springfield, Mass., studied patients with two "bread-and-butter" illnesses -- pneumonia and chronic obstructive pulmonary disease. He found that patients fared the same whether they were treated at a major hospital or a community hospital.

One difference Lindenauer observed is that patients with pneumonia had a 72% chance of obtaining antibiotics within four hours of arrival at community hospitals, compared with a 56% chance at large teaching hospitals. He said that the study was not able to determine the reason for the difference.

In a study of Medicare data, John Birkmeyer, a professor of surgery at the University of Michigan, found that heart surgery patients may be better off under the care of surgeons with more experience. According to Birkmeyer, "High-volume surgeons at lower-volume hospitals did just as well as high-volume surgeons at high-volume centers."

Cancer patients, on the other hand, tend to receive the best care at those facilities where there are a larger number of cancer patients, Birkmeyer found. High-volume facilities also double the chances of survival for patients undergoing esophageal operations. Birkmeyer's findings will be published in a future issue of the Annals of Surgery.

Elliot Fisher, a professor at Dartmouth Medical School, said the limited knowledge about the differences in the quality of care at community and large hospitals is "the greatest weakness of all the efforts to foster consumer engagement in health care decision making" (Kolata, New York Times, 7/2).