A study in this week’s New England Journal of Medicine might seem to be sending a confusing message to lay readers.

On one hand, high-volume hospitals produced better outcomes for three common problems Medicare patients face—heart attack, heart failure and stroke—but on the other, the study says smaller hospitals can do a good job, too.

All health care is, indeed, local and it is most especially local when someone may be having a heart attack, cannot breath because of fluid build-up caused by heart failure or may have a dangerous pneumonia. This AP story makes this point but it needs to be made forcefully.

In urgent or emergency situations, go immediately to the nearest hospital, period.

When there is time to consider which hospital may be best, Medicare offers an online checker, Hospital Compare. This tool considers all the measures, not just volumes. It examines hospital performance for a wide variety of diagnoses, for example.

It is all too easy to use hospital volume as a default decision point.

What matters to you or your patient is a combination of the doctors available, the hospital’s overall quality ratings and the speed with which you need care.

For city dwellers, whose neighborhood hospital happens to be a high volume hospital with an excellent reputation, you are set.

For everyone else, it will pay big dividends to use Hospital Compare to understand the hospitals in your area—the ones closest to you as well as in your community—before you might need one.

AP

“People hospitalized with a heart attack, heart failure or pneumonia fare better if they are admitted someplace that treats a lot of those problems, a large study of Medicare patients finds.

“Busier hospitals on average tended to have lower rates of death from these three common conditions than smaller hospitals. The risk of death dropped until the number treated reached 610 heart attacks, 500 heart failures and 210 pneumonia cases a year, the study showed. After that point, the number treated didn’t change the outcome.

“What does this mean for patients?

“In an emergency, people should still head to the nearest hospital.

“Experience does matter, but if you’re in the middle of a heart attack, you don’t choose which hospital you go to,” said Dr. Mark Hlatky, a professor of health research and policy at Stanford University, who had no role in the study.”

Source: AP, March 24, 2010

Citation: NEJM, Vol. 362: 1110-1118, March 25, 2010, Number 12