The Association Between Hospital Care Intensity and Surgical Outcomes in Medicare Patients

IMPORTANCE Hospitals' care intensity varies widely across the United States. Payers and policy makers have become focused on promoting quality, low-cost, efficient health care. OBJECTIVE To evaluate whether increased hospital care intensity (HCI) is associated with improved outcomes following major surgery. DESIGN, SETTING, AND PARTICIPANTS Using national Medicare data in this retrospective cohort study, we identified 706 520 patients at 2544 hospitals who underwent 1 of 7 major cardiovascular, orthopedic, or general surgical operations. EXPOSURE The HCI Index, which is validated and publicly available through the Dartmouth Atlas of Healthcare. MAIN OUTCOMES AND MEASURES Risk-and reliability-adjusted mortality, major complication, and failure-to-rescue rates. RESULTS Hospital care intensity varied 10-fold. High-HCI hospitals had greater rates of major complications when compared with low-HCI centers (risk ratio, 1.04; 95% CI, 1.03-1.05). There was a decrease in failure to rescue at high compared with low-HCI hospitals (risk ratio, 0.95; 95% CI, 0.94-0.97). Using multilevel-models, HCI reduced the variation in failure-to-rescue rates between hospitals by 2.7% after accounting for patient comorbidities and hospital resources. Patients treated at high-HCI hospitals had longer hospitalizations, more inpatient deaths, and lower hospice use during the last 2 years of life. CONCLUSIONS AND RELEVANCE Failure-to-rescue rates were lower at high-care intensity hospitals. Conversely, care intensity explains a very small proportion of variation in failure-to-rescue rates across hospitals.