Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

When comparing teaching hospitals, context matters

Joanne Conroy, MD
Education
November 24, 2012
Share
Tweet
Share

The Dartmouth Atlas Project released a study on October 30, 2012, entitled, “What Kind of Physician Will You Be? Variation in Health Care and Its Importance for Residency Training.” The data, and the conclusions of the report’s authors, bear closer examination.

The data set focuses on the differences in the intensity of services that Medicare patients receive, and highlights the academic medical centers rated by U.S. News and World Report as the best hospitals for clinical excellence in 2012-13. The 24-page report, authored by two Geisel Medical School students, was issued to inform medical students about the practices at teaching hospitals where they may receive further training.

All data is helpful, but it only begins the conversation. The authors hold underlying assumptions and perpetrate inconsistencies in their analysis that should be addressed. I don’t suggest dismissing their findings, but rather proceeding with caution.

First, the authors include publicly available information from Hospital Compare , but don’t highlight patient mortality as a quality indicator. Of the seven hospitals in the United States that have attained four successive “Better than U.S. National Rate” ratings for all three 30-day death measures on heart attack, heart failure, and pneumonia patients, several are prominently displayed at the top of the “intensity of care” list.

These hospitals are:

  • Cedars-Sinai Medical Center, Los Angeles, CA
  • Hackensack University Medical Center, Hackensack, NJ
  • Maimonides Medical Center, Brooklyn, NY
  • Mount Sinai Medical Center, Miami Beach, FL
  • New York-Presbyterian Hospital, New York, NY
  • NYU Hospitals Center, New York, NY
  • Yale-New Haven Hospital, New Haven, CT

What does it mean to be on that list? For the 2012 update, to achieve even a single “Better than U.S. National Rate” rating, a hospital must be in the top 2 to 4 percent. There are 22 facilities that achieved all three “Better” ratings — about 0.45 percent of nearly 5,000 hospitals reporting. These seven hospitals are better than 99.85 percent of the reporting hospitals — an extremely difficult achievement! (The data cited here is courtesy of Alein Chun, PhD, IQCP Manager, Data Quality Management Unit (DQMU), Cedars-Sinai.)

This begs the question, does a greater intensity of care lead to decrease in mortality in complex patients?

Context for the data is extremely important — and enlightening. New York’s Mount Sinai scores very low on the metric reflecting the percentage of patients referred to hospice in the last six months of life. However, Mount Sinai has one of the premier palliative care programs in the country. The inpatient surgical rate for knee replacement was highest in Salt Lake City, Utah. Does that data reflect a population that self-selects, because many 65-year-old ski bums have winter homes in the Wasatch Mountains?

Data is critical for generating the information we need to identify problems and create solutions, to better manage the health of populations and best deploy our resources. But data is not, in itself, knowledge. It must be analyzed, put into context, and thoughtfully debated to become information, which is then deployed to knowledge. The release of the Dartmouth Atlas Project report creates a great opportunity for all teaching hospitals to reflect on how they are delivering care; and to begin the important conversations about the differences in regional and population utilization.

Joanne Conroy is Chief Health Care Officer at the Association of American Medical Colleges.  She blogs at Wing of Zock and can be reached on Twitter @joanneconroymd.

Prev

What would your personal health checklist look like?

November 24, 2012 Kevin 5
…
Next

Receiving disability payments is more difficult than one might think

November 25, 2012 Kevin 5
…

Tagged as: Hospital-Based Medicine, Medical school

Post navigation

< Previous Post
What would your personal health checklist look like?
Next Post >
Receiving disability payments is more difficult than one might think

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Joanne Conroy, MD

  • What a hospital CEO learned from Nordstrom

    Joanne Conroy, MD
  • 5 sensible ways to decrease medical school debt

    Joanne Conroy, MD
  • a desk with keyboard and ipad with the kevinmd logo

    How physician-owned hospitals are making teaching hospitals pay

    Joanne Conroy, MD

More in Education

  • The hidden cost of becoming a doctor: a South Asian perspective

    Momeina Aslam
  • From burnout to balance: a lesson in self-care for future doctors

    Seetha Aribindi
  • Why young doctors in South Korea feel broken before they even begin

    Anonymous
  • Why medical students are trading empathy for publications

    Vijay Rajput, MD
  • Why a fourth year will not fix emergency medicine’s real problems

    Anna Heffron, MD, PhD & Polly Wiltz, DO
  • Do Jewish students face rising bias in holistic admissions?

    Anonymous
  • Most Popular

  • Past Week

    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • When a doctor becomes the narrator of a patient’s final chapter

      Ryan McCarthy, MD | Physician
    • When errors of nature are treated as medical negligence

      Howard Smith, MD | Physician
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • When a doctor becomes the narrator of a patient’s final chapter

      Ryan McCarthy, MD | Physician
    • Why innovation in health care starts with bold thinking

      Miguel Villagra, MD | Tech
    • Navigating fair market value as an independent or locum tenens physician [PODCAST]

      The Podcast by KevinMD | Podcast
    • Gaslighting and professional licensing: a call for reform

      Donald J. Murphy, MD | Physician
    • How self-improving AI systems are redefining intelligence and what it means for health care

      Harvey Castro, MD, MBA | Tech
    • How blockchain could rescue nursing home patients from deadly miscommunication

      Adwait Chafale | Tech

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • When a doctor becomes the narrator of a patient’s final chapter

      Ryan McCarthy, MD | Physician
    • When errors of nature are treated as medical negligence

      Howard Smith, MD | Physician
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • When a doctor becomes the narrator of a patient’s final chapter

      Ryan McCarthy, MD | Physician
    • Why innovation in health care starts with bold thinking

      Miguel Villagra, MD | Tech
    • Navigating fair market value as an independent or locum tenens physician [PODCAST]

      The Podcast by KevinMD | Podcast
    • Gaslighting and professional licensing: a call for reform

      Donald J. Murphy, MD | Physician
    • How self-improving AI systems are redefining intelligence and what it means for health care

      Harvey Castro, MD, MBA | Tech
    • How blockchain could rescue nursing home patients from deadly miscommunication

      Adwait Chafale | Tech

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...