{"id":44235,"date":"2014-08-07T14:37:35","date_gmt":"2014-08-07T18:37:35","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&p=44235"},"modified":"2014-08-07T14:37:35","modified_gmt":"2014-08-07T18:37:35","slug":"how-should-we-weigh-the-value-of-hospitals","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2014\/08\/07\/how-should-we-weigh-the-value-of-hospitals\/","title":{"rendered":"How Should We Evaluate Hospital Care?"},"content":{"rendered":"

CardioExchange’s Harlan Krumholz<\/strong>\u00a0asked Dr. Xiao Xu<\/strong> to discuss recent findings from her study of hospital differences in cost and clinical outcomes for heart failure treatment in a broad sample\u00a0of hospitals. The study,\u00a0\u201cPhenotyping\u201d Hospital Value of Care for Patients with Heart Failure<\/a>, is published in\u00a0<\/em>Health Services Research, and the figure depicting the 5 distinct phenotypes is reprinted below.\u00a0Each panel in the figure reflects one hospital phenotype\u2014that is, a distinct group of hospitals that experience a unique pattern of risk-standardized cost (RSC) and risk-standardized mortality rate (RSMR) over time.<\/em><\/p>\n

\"Figure<\/a>

Reprinted from Xu X et al. “Phenotyping” Hospital Value of Care for Patients with Heart Failure. Health Services Research<\/i>. doi: 10.1111\/1475-6773.12197 \u00a9 2014 The Health Research and Educational Trust<\/p><\/div>\n

As a health economist, I am certainly interested in ways to reduce health care costs, but I am more concerned about how we can slow the rising costs without adverse consequences to patients. This requires us to think about value\u2014i.e., cost in the context of outcomes. Can we lower costs while improving\u2014or at least maintaining\u2014patient outcomes?<\/p>\n

One approach is to look at our current system and try to understand who is achieving the best value and investigate how they are doing it. In our paper, we phenotype hospitals by the value of their care for patients with heart failure. In addition to cost, we look at mortality to see which hospitals achieve low mortality at low cost.<\/p>\n

In this process, we notice some very interesting patterns. Some hospitals have similar mortality rates but very different costs, while others have similar costs but quite distinct mortality rates\u2014and this is after accounting for how sick their patients are. What does this tell us? Hospitals vary considerably in how they turn inputs into outputs.<\/p>\n

This provides a superb opportunity for hospitals to learn from each other. If all hospitals can emulate high-value hospitals\u2014those with low mortality and low cost\u2014we will save tremendous health care dollars as well as patients’ lives. A dual focus on both cost and patient health outcomes should be the new lens through which we see health care now.<\/p>\n","protected":false},"excerpt":{"rendered":"

Dr. Xiao Xu weighs in on the question of how we should quantify the cost-effectiveness of hospital care.<\/p>\n","protected":false},"author":646,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[516,287,801],"class_list":["post-44235","post","type-post","status-publish","format-standard","hentry","category-general","tag-cost-effectiveness","tag-heart-failure-2","tag-mortality"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/44235","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/646"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=44235"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/44235\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=44235"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=44235"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=44235"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}