'中心 of Excellence' may not mean より小数の deaths or readmissions
By Lisa Rapaport
(Reuters Health) - Select hospitals 指定するd as "中心s of Excellence" by major U.S. health 計画（する）s may not やむを得ず have lower death 率s or より小数の repeat admissions than other hospitals, a 熟考する／考慮する of heart 患者s 示唆するs.
Several health 保険 計画（する）s have created 中心s of Excellence (COE) programs to identify hospitals that 配達する high 質 care. A growing number of American 患者s find that health 計画（する）s are trying to 限界 their choice of hospitals and doctors to 中心s of Excellence, but whether steering 患者s to these particular hospitals leads to better 結果s hasn't been （疑いを）晴らす.
For the 現在の 熟考する／考慮する, 研究員s 診察するd data on 率s of 30-day mortality and readmission, or repeat 入院, at 62 hospitals in New York 明言する／公表する, 焦点（を合わせる）ing on 患者s who had a heart attack or 手続きs to 回復する 血 flow to the heart. This 含むd five hospitals with a COE 任命 from Aetna, nine with a COE 任命 from Cigna, and 17 with a COE 任命 from Blue Cross Blue 保護物，者 (BCBS).
Hospitals with Aetna's COE 任命 had a higher 普通の／平均（する） 30-day mortality 率 than other hospitals, with 1.4 versus 1.1 fatalities for every 100 いわゆる percutaneous coronary 介入 (PCI) 手続きs to 回復する 血 flow to the heart.
There wasn't a meaningful difference in PCI mortality 率s with COE 任命s from Cigna or BCBS. And, 非，不，無 of the three COE programs appeared to make a meaningful difference in mortality 率s for heart attacks.
"Although the goal is to help guide 患者s to high 質 hospitals that are also more cost-efficient, at this point it does not appear that these programs 終始一貫して identify such high 質 hospitals," said lead 熟考する／考慮する author Dr. Sameed Khatana of the Perelman School of 薬／医学 at the University of Pennsylvania in Philadelphia.
"Since our 熟考する／考慮する was 焦点（を合わせる）d only on cardiovascular 病気 and 介入s, it is diffi 教団 to generalize to other 質 任命 programs, however, cardiac stenting is one of the most ありふれた invasive 手続きs 成し遂げるd in the U.S. with 井戸／弁護士席-設立するd 業績／成果 対策," Khatana said by email.
One 制限 of the 熟考する／考慮する is that it had a small number of hospitals, and it's also possible that hospitals might 異なる on 質 対策 that weren't 手段d in the 現在の 分析, 研究員s 公式文書，認める in JAMA 内部の 薬／医学.
But the results 示唆する that 患者s shouldn't rely on COE 任命s to find the best place to go for their care, said Dr. Deepak Bhatt, (n)役員／(a)執行力のある director of interventional cardiovascular programs at Brigham and Women's Heart & Vascular 中心 in Boston.
"保険会社s likely make these 決意s まず第一に／本来 based on cost to them," Bhatt, who wasn't 伴う／関わるd in the 熟考する／考慮する, said by email. "患者s should not assume that these 任命s 反映する actual 質 or 結果s."
With a typical COE 協定, 保険会社s will give this 任命 to a hospital for a 扱う／治療するing a 確かな 病気 or 成し遂げるing a 明確な／細部 type of 外科 and then 限界 the number of places in their ニュース報道 網状組織 where 患者s can go for these things, said Dr. Daniel Blumenthal, a cardiologist at Massachusetts General Hopsital in Boston who wasn't 伴う／関わるd in the 熟考する／考慮する.
This helps 確実にする that a high 容積／容量 of the 保険会社's 患者 go to the 指定するd hospital, and the COE will typically agree to lower 支払い（額） 率s in return, Blumenthal said by email. いつかs, 保険会社s also steer 患者s to COEs by 減ずるing or 除去するing out-of-pocket co-支払い（額）s for services at these hospitals.
"If care 質 is 類似の across hospitals, costs of care probably should be a central consideration for 患者s as they 熟視する／熟考する where to go," Blumenthal said.
This is 特に true for 患者s that have いわゆる high deductible health 計画（する）s that can often come with lower 月毎の 賞与金s but higher out-of-pocket 料金s for care, said Dr. Willi am Borden, 長，指導者 質 and 全住民 health officer at George Washington University 医療の Faculty Associates in Washington, D.C.
"With the growth of high-deductible health 計画（する）s and greater copays in general, 患者s are 明確に going to be swayed by lower out-of-pocket costs, 特に when there is a label 示すing that that hospital may also have higher 質," Borden, who wasn't 伴う／関わるd in the 熟考する／考慮する, said by email.
SOURCE: http://bit.ly/2YDTlOE JAMA 内部の 薬／医学, online May 20, 2019.
