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ADVANCE Perspective: Respiratory Views

Size Really Does Matter In Health Care Delivery

Published March 31, 2010 1:57 PM by Vern Enge
Imagine yourself in a popular vacation shore community, warm rays of summer soothing your work-weary body. In the middle of the night, you wake to indigestion and pain in your chest and arm. You know you're in serious trouble. As one of a million heart attack patients in the U.S. each year, where do you go for help?

"If you're in the middle of a heart attack, you don't choose which hospital you go to," Mark Hlatky, MD, professor of health research and policy at Stanford University, told the AP.

In an emergency, people simply head to the nearest hospital or dial 911 and ask operators to send an ambulance. There is little time to shop around for care.

Nonetheless, given a choice, bigger may be better when it comes to patient care. Bigger hospitals may generally treat some conditions better than do smaller ones, according to a study printed recently in the New England Journal of Medicine.

In a large study of Medicare patients, researchers found busier hospitals on average tended to have lower rates of death from three common conditions - heart attack, heart failure, or pneumonia - than do smaller facilities.

This is not something inherently new. Various studies over the years have shown that facilities performing large numbers of procedures, for example heart transplants, have better survival rates than those who do only minimal numbers.

One important factor in health care centers on survival rates. Patients in larger hospitals had an 11 percent better chance of surviving a heart attack, a 9 percent better chance of a hospital release following heart failure, and a 5 percent improved outcome following pneumonia than did patients in smaller facilities.

Stats were based on 750,000 heart attack patients and 1 million heart failure and 1 million pneumonia patients treated at more than 4,000 hospitals.

Volume, however, does not negate quality of care issues, according to research leader Joseph Ross, MD, of Mount Sinai School of Medicine in New York. Not all hospitals can deliver quality care regardless of their size.

How well does your hospital hold up? Comparative data on hospital care can be found at

This is a good site for therapists to scan to compare their quality of care and patient outcomes against other hospitals across the nation.

Still, quality of care should be the major concern for all therapists every single day in every location, and there is little doubt therapists do give their best, regardless of the size of their facility or their range of patients.

As a therapist, how do you feel about care? Is bigger better?


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