Hospital use and mortality among Medicare beneficiaries in Boston and New Haven

J. E. Wennberg, J. L. Freeman, R. M. Shelton, T. A. Bubolz

Research output: Contribution to journalArticle

258 Citations (Scopus)

Abstract

We compared rates of hospital use and mortality in fiscal year 1985 among Medicare enrollees in Boston and New Haven, Connecticut. Adjusted rates of discharge, readmission, length of stay, and reimbursement were 47, 29, 15, and 79 percent higher, respectively, in Boston; 40 percent of Boston's deaths occurred in hospitals as compared with 32 percent of New Haven's. High-variation medical conditions (those for which there is little consensus about the need for hospitalization) accounted for most of these differences. By contrast, discharge rates for low-variation medical conditions (which tend to reflect the incidence of disease) were similar. Inpatient case-fatality rates were lower in Boston than in New Haven (RR = 0.85; 95 percent confidence interval, 0.78 to 0.92), but when all deaths (regardless of place of death) were measured, the mortality rates in Boston and New Haven were nearly identical (RR = 0.99; 95 percent confidence interval, 0.93 to 1.05). We conclude that the lower rate of hospital use by Medicare enrollees in New Haven was not associated with a higher overall mortality rate. Population-based as well as hospital-based statistics are needed to evaluate differences in hospital mortality rates for high-variation medical conditions.

Original languageEnglish (US)
Pages (from-to)1168-1173
Number of pages6
JournalNew England Journal of Medicine
Volume321
Issue number17
StatePublished - 1989
Externally publishedYes

Fingerprint

Medicare
Hospital Mortality
Mortality
Confidence Intervals
Inpatients
Length of Stay
Hospitalization
Incidence
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Wennberg, J. E., Freeman, J. L., Shelton, R. M., & Bubolz, T. A. (1989). Hospital use and mortality among Medicare beneficiaries in Boston and New Haven. New England Journal of Medicine, 321(17), 1168-1173.

Hospital use and mortality among Medicare beneficiaries in Boston and New Haven. / Wennberg, J. E.; Freeman, J. L.; Shelton, R. M.; Bubolz, T. A.

In: New England Journal of Medicine, Vol. 321, No. 17, 1989, p. 1168-1173.

Research output: Contribution to journalArticle

Wennberg, JE, Freeman, JL, Shelton, RM & Bubolz, TA 1989, 'Hospital use and mortality among Medicare beneficiaries in Boston and New Haven', New England Journal of Medicine, vol. 321, no. 17, pp. 1168-1173.
Wennberg JE, Freeman JL, Shelton RM, Bubolz TA. Hospital use and mortality among Medicare beneficiaries in Boston and New Haven. New England Journal of Medicine. 1989;321(17):1168-1173.
Wennberg, J. E. ; Freeman, J. L. ; Shelton, R. M. ; Bubolz, T. A. / Hospital use and mortality among Medicare beneficiaries in Boston and New Haven. In: New England Journal of Medicine. 1989 ; Vol. 321, No. 17. pp. 1168-1173.
@article{a3793abd8fec4777a1f74c9ba066f6c4,
title = "Hospital use and mortality among Medicare beneficiaries in Boston and New Haven",
abstract = "We compared rates of hospital use and mortality in fiscal year 1985 among Medicare enrollees in Boston and New Haven, Connecticut. Adjusted rates of discharge, readmission, length of stay, and reimbursement were 47, 29, 15, and 79 percent higher, respectively, in Boston; 40 percent of Boston's deaths occurred in hospitals as compared with 32 percent of New Haven's. High-variation medical conditions (those for which there is little consensus about the need for hospitalization) accounted for most of these differences. By contrast, discharge rates for low-variation medical conditions (which tend to reflect the incidence of disease) were similar. Inpatient case-fatality rates were lower in Boston than in New Haven (RR = 0.85; 95 percent confidence interval, 0.78 to 0.92), but when all deaths (regardless of place of death) were measured, the mortality rates in Boston and New Haven were nearly identical (RR = 0.99; 95 percent confidence interval, 0.93 to 1.05). We conclude that the lower rate of hospital use by Medicare enrollees in New Haven was not associated with a higher overall mortality rate. Population-based as well as hospital-based statistics are needed to evaluate differences in hospital mortality rates for high-variation medical conditions.",
author = "Wennberg, {J. E.} and Freeman, {J. L.} and Shelton, {R. M.} and Bubolz, {T. A.}",
year = "1989",
language = "English (US)",
volume = "321",
pages = "1168--1173",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "17",

}

TY - JOUR

T1 - Hospital use and mortality among Medicare beneficiaries in Boston and New Haven

AU - Wennberg, J. E.

AU - Freeman, J. L.

AU - Shelton, R. M.

AU - Bubolz, T. A.

PY - 1989

Y1 - 1989

N2 - We compared rates of hospital use and mortality in fiscal year 1985 among Medicare enrollees in Boston and New Haven, Connecticut. Adjusted rates of discharge, readmission, length of stay, and reimbursement were 47, 29, 15, and 79 percent higher, respectively, in Boston; 40 percent of Boston's deaths occurred in hospitals as compared with 32 percent of New Haven's. High-variation medical conditions (those for which there is little consensus about the need for hospitalization) accounted for most of these differences. By contrast, discharge rates for low-variation medical conditions (which tend to reflect the incidence of disease) were similar. Inpatient case-fatality rates were lower in Boston than in New Haven (RR = 0.85; 95 percent confidence interval, 0.78 to 0.92), but when all deaths (regardless of place of death) were measured, the mortality rates in Boston and New Haven were nearly identical (RR = 0.99; 95 percent confidence interval, 0.93 to 1.05). We conclude that the lower rate of hospital use by Medicare enrollees in New Haven was not associated with a higher overall mortality rate. Population-based as well as hospital-based statistics are needed to evaluate differences in hospital mortality rates for high-variation medical conditions.

AB - We compared rates of hospital use and mortality in fiscal year 1985 among Medicare enrollees in Boston and New Haven, Connecticut. Adjusted rates of discharge, readmission, length of stay, and reimbursement were 47, 29, 15, and 79 percent higher, respectively, in Boston; 40 percent of Boston's deaths occurred in hospitals as compared with 32 percent of New Haven's. High-variation medical conditions (those for which there is little consensus about the need for hospitalization) accounted for most of these differences. By contrast, discharge rates for low-variation medical conditions (which tend to reflect the incidence of disease) were similar. Inpatient case-fatality rates were lower in Boston than in New Haven (RR = 0.85; 95 percent confidence interval, 0.78 to 0.92), but when all deaths (regardless of place of death) were measured, the mortality rates in Boston and New Haven were nearly identical (RR = 0.99; 95 percent confidence interval, 0.93 to 1.05). We conclude that the lower rate of hospital use by Medicare enrollees in New Haven was not associated with a higher overall mortality rate. Population-based as well as hospital-based statistics are needed to evaluate differences in hospital mortality rates for high-variation medical conditions.

UR - http://www.scopus.com/inward/record.url?scp=0024374171&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0024374171&partnerID=8YFLogxK

M3 - Article

VL - 321

SP - 1168

EP - 1173

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 17

ER -