Clinical Excellence

Apr 9 2008

Study: Hospital Stays Vary Less in Kaiser Permanente Hospitals than Others in California

The number of hospital days across Kaiser Permanente's 28 California hospitals varies less than among non-Kaiser facilities for chronically ill Medicare patients seen in their last two years of life, according to a Stanford University study.

The findings are included in a study led by Laurence C. Baker, Ph.D., professor of Health Research and Policy and chief of the Health Services Research at the Stanford University School of Medicine, and funded by the California HealthCare Foundation. The complete report, Same Disease, Different Care: How Patient Health Coverage Drives Treatment Patterns in California, is available on the CHCF website.
 
Baker compared medical services for Medicare and private HMO patients in Kaiser Permanente facilities in California, which are among the most tightly managed health care settings in the country. He found similar chronically ill Kaiser Permanente patients in Southern California received slightly more treatment in the last two years of life than in Northern California.
 
"While not definitive, one interpretation of these results is that care integration could play a role in variations in hospital-use patterns," Baker writes in the study.

The study coincides with the release of the latest update to the Dartmouth Atlas of Health Care, a continuing analysis by Dartmouth researchers on national variations in the delivery and cost of treatment for those with chronic diseases.
 
The Dartmouth report this year focused, in part, on variation in care in the Los Angeles area and found that chronically ill Medicare patients — some within just a few blocks of each other — experience very different courses of treatment in the two years prior to their deaths, depending upon the resources available and the practice style at each hospital.

"The findings are consistent with Kaiser Permanente's internal analysis of variation using the Dartmouth Atlas methods. In our examination of hospital utilization in the last six months of life (compared to two years in this study), we found the range among KP residence areas for Medicare consistent with the range (ratio of 1.5) reported in the article," said Matt Stiefel, senior director, Quality/Care Management Institute. "We also found in our study that hospice utilization in KP was higher than in the surrounding communities, and that greater hospice use was associated with less ICU use. This is especially important, given the evidence suggesting that more, or more intensive, care for this population is neither necessarily better nor desired by patients."

For details, read the full press release from the California HealthCare Foundation.

Additional information about the Dartmouth Atlas applied to Kaiser Permanente was published in the Winter 2008 edition of The Permanente Journal.