YONKERS, NY — Consumer Reports, working with the Dartmouth Atlas Project, is launching a new free Web tool at www.ConsumerReportsHealth.org that illustrates for consumers the wide variation in treatment they can expect for serious chronic conditions depending on which hospital provides their care.  The tool, which ranks nearly 3,000 U.S. hospitals, exposes sharp contrasts in the amount of time people with serious chronic conditions spend in the hospital and how much they will pay.  These large variations in hospital care point to an unmet need for greater public education about how to navigate our complicated health-care system.

“Too Much Treatment” 

Consumer Reports’ new hospital-rankings Web tool (www.ConsumerReportsHealth.org) is highlighted in an in-depth report published in its July issue.  The report, entitled “Too Much Treatment,” compares the approach of hospitals and doctors toward chronic life-threatening illnesses across the country.  Consumer Reports contrasts aggressive care with conservative care, noting that aggressive care can, in some cases, shorten a person’s life by subjecting the patient to more treatments, more time in the hospital, and hence increased risk of medical errors and infection. 

“Consumer Reports is the perfect partner to help put this information in the hands of consumers,” said Jack Wennberg, M.D., M.P.H., the founder of the Dartmouth Atlas Project.  The 2008 Atlas (www.dartmouthatlas.org) studied the experiences of 4,732,448 Medicare patients at 2,878 U.S. hospitals during the last two years of life.  Those patients, all 65 and older, were treated for the top nine leading causes of death, including (in order of prevalence), congestive heart failure, chronic pulmonary disease, cancer, dementia, coronary artery disease, chronic kidney failure, peripheral vascular (circulatory) disease, diabetes with organ damage, and severe chronic liver disease.   The Atlas was authored by Wennberg and colleagues from the Dartmouth Institute for Health Policy and Clinical Practice at Dartmouth College.  Principle funding for the Atlas comes from the Robert Wood Johnson Foundation. 

Consumer Reports Health Ratings Center

At www.ConsumerReportsHealth.org, consumers will find information and ratings for health-related products, drugs, and treatments, and the new hospital web tool.   The  hospital  rankings  represent the first project of the new Consumer Reports Health Ratings Center.  The Health Ratings Center was initiated this month and will be directed by John Santa, M.D., M.P.H.   Prior to joining Consumer Reports, Santa was best known for his work with the innovative Drug Effectiveness Review Project (DERP), which develops evidence-based reviews that evaluate and compare prescription medications.  Santa was medical director at DERP from 2003 to 2006.  The DERP drug reviews have been a cornerstone of the Consumer Reports Best Buy Drugs project, launched in December 2004.

“Studies from Dartmouth indicate that aggressive care doesn’t necessarily prolong life, but it often extends the amount of time a patient spends in the hospital and the out-of-pocket cost for that care,” said Dr. Santa.   Emphasizing that the hospital comparisons only pertain to chronic diseases such as heart failure, cancer, and chronic kidney failure, Santa added that this information does not assess the quality of hospital care.  CR’s July report describes several studies that have drawn a connection between the extra care administered in high-spending, aggressive-care regions, and diminished quality of care.   One study, by the nonpartisan Congressional Budget Office, found a reverse correlation between per capita Medicare spending and care quality; the percentage of patients hospitalized with heart attacks, pneumonia, and heart failure who received the recommended treatments was lower in high-spending areas. 

Defining The Spectrum of Care from “Aggressive” to “Conservative” 

The new web tool, available online at www.ConsumerReportsHealth.org, ranks each hospital based on how aggressively it treats the nine chronic conditions on a percentile scale of 0-100, with 100 being the most aggressive and 0 being the most conservative.  The percentile rank is based on the total number of hospital days and inpatient physician visits over the last two years of life.  And for each hospital, the tool also displays the patient out-of-pocket costs over the last two years of life.   “Aggressive” care means frequent diagnostic tests and doctor visits, more reliance on specialists instead of primary care doctors, prolonged hospital stays, more days in the intensive care unit, and higher out-of-pocket expenditures.   “Conservative” care represents the flip side of “aggressive” care—fewer tests, fewer hospital and ICU days, fewer doctor visits, and a lower out-of-pocket expenditure.

By The Numbers: Aggressive vs. Conservative Treatment 

If you live in New York, Los Angeles, or Miami, you could spend a lot of time in the hospital getting the most aggressive hospital care in the country.  The most aggressive hospitals in these cities are NYU Langone Medical Center in New York City, Alhambra Hospital Medical Center and Pacific Alliance Medical Center, both in L.A., and Westchester General Hospital and Mt. Sinai Medical Center, both in Miami.  L.A. has the distinction of being home to a total of 40 hospitals that are ranked in the 90th percentile and above, indicating that they’re more aggressive than 90 percent of the hospitals studied.

In the last two years of life, patients 65 or older saw a doctor an average of 109 times in L.A. and 88 times in Manhattan, whereas in Seattle, known for conservative care in its hospitals, a patient will see a doctor an average of 45 times.  Cost differences are substantial, from a high of $81,143 in average costs in the Manhattan area to a moderate $43,218 in Seattle, Washington, to a low of $29,116 in Dubuque, Iowa.

CR notes in its July report, “Too Much Treatment,” some striking insights from the Dartmouth researchers, including the fact that patients have a slightly higher death rate in aggressive regions, which deliver the most care.   “This is a heads up to people being treated for serious chronic conditions that they may be at risk of unnecessary treatments that may not be beneficial,” said Nancy Metcalf, health editor at Consumer Reports.  “The purpose of the report is to lay out in plain terms how hospital A and hospital B could be strikingly different in terms of how they care for patients, and provide a clear plan of action for consumers so they can be sure to ask the right questions and increase their chances of getting the most effective care,” said Metcalf.

Get Better Care, No Matter Where

For people with serious long-term illnesses, navigating America’s health-care system can be daunting.  Here are some ways patients and family members can get better care, regardless of the type of hospital they’re in. More details are available online at www.ConsumerReportsHealth.org.

• Know your hospital: Use CR’s free online tool available at www.ConsumerReportsHealth.org and work with your primary-care doctor or the specialist in charge to help you avoid unneeded hospitalizations. If you have a choice, consider using a doctor attached to the hospital that practices conservative care.  When hospitalization is necessary, recruit a friend or family member to be present and monitor your care.

• Ask about pros and cons:  Just because a test or treatment can be done doesn’t mean it should be done.  For tests, ask whether the test will change the way the doctor treats the disease.  If the answer is “no,” ask what is the benefit? Will the test likely lead to follow-up tests, biopsies, or other diagnostic procedures?  And how will this benefit your health?  For treatments, ask if it is likely to extend your life and if so, for how long? How will side effects and risks compare with the symptoms and risks of the disease itself? What will happen if the treatment is not given?

• Push for coordination: Having many doctors involved can lead to confusion and miscommunication, which in turn can lead to medication errors.  Identify a single doctor to coordinate your care.  Keep a record of your care and always ask to have records sent to your main doctor and yourself.  Keep an up-to-date list of all the medications you’re taking and any side effects you’ve encountered.