Posting date: October 7, 2004

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Health Affairs, 10.1377/hlthaff.var.19
Copyright © 2004 by Project HOPE

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Variations In The Longitudinal Efficiency Of Academic Medical Centers

¹ Elliott Fisher is a professor of medicine and of community and family medicine at Dartmouth Medical School in Hanover, New Hampshire, and is codirector of the Veterans Affairs (VA) Outcomes Group at the White River Junction (Vermont) VA Medical Center.
² David Wennberg directs the Center for Outcomes Research and Evaluation, Maine Medical Center, in Portland.
³ Thérèse Stukel is a senior scientist and research director at the Institute for Clinical Evaluative Sciences, Toronto, Ontario.
⁴ Dan Gottlieb is a research associate at the Center for the Evaluative Clinical Sciences, Dartmouth Medical School.

^*Corresponding author.

Abstract

Recent studies have revealed dramatic differences among academic medical centers (AMCs) in the quantity of care provided to their patients. The implications, however, depend upon whether the additional resources provided by some centers lead to better results. This study describes the content, quality, and outcomes of care across AMCs that differ by up to 60 percent in the overall intensity of medical services delivered to patients with serious chronic illnesses. Efforts to reduce costs will require attention to supply-sensitive services (the frequency of hospital stays, physician visits, specialist consultations, diagnostic tests, and minor procedures) and should include a focus on the longitudinal efficiency of hospitals and medical staffs.

Key Words: Chronic Care, Hospitals, Quality Of Care, Variations

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