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When Your Life Depends on It

Where you are treated is often critical to recovery from an illness

Whether it's fine clothes or a new car, a great kitchen or where your child attends college, "only the best" is a standard that many aspire to but few can afford. Fortunately, there are plenty of perfectly fine alternatives to driving a new Mercedes or eating from a set of Belleek china that won't bankrupt you. But what if the consumer decision you are confronted with is where to get open-heart surgery or have an injured hip repaired? Considering how high the stakes might be then, "only the best" might not seem such an unreasonable standard to apply.

Indeed, recent research supports what many will have figured out on their own: When it comes to specialized medical procedures requiring hospitalization, where you go for treatment is often critical to whether you are treated successfully. In one recent study published in the Journal of the American Medical Association, for instance, researchers Harold S. Luft and Patrick S. Romano of the University of California found that death rates from high-risk heart bypass operations could be significantly reduced if the procedures were done at hospitals with consistently low death rates for the surgery.

Using the records of 115 California hospitals that had performed five or more coronary artery bypass operations annually in any year between 1983 and 1989, the researchers developed a methodology for determining when a hospital's death rates for the procedure were higher - or lower - than would ordinarily be expected, given the severity of the disease.

If death rates were merely a function of chance or the difficulty of measuring differences in the seriousness of the patients' conditions, then a hospital that performed well one year would not necessarily excel in a later period, the researchers reasoned.

What they discovered, however, was that hospitals that had significantly lower death rates for the first period tended to maintain that record two years later, while hospitals that compared poorly the first time around continued to do poorly two years later.

The researcher's general thrust was bolstered by a second study published recently in the journal Annals of Surgery. There, researchers found that patients were six times more likely to die of a complex pancreatic cancer surgery at hospitals that only attempt the operation a few times a year than at a large regional medical center that performs the procedure on a regular basis.

This is not to say that you need to seek out treatment at a major regional medical center in all cases. There are many conditions that a local hospital or doctor is likely to be fully capable of handling and where postoperative care may be more effectively handled. The quality of a hospital's nursing staff is often critical to the success of the patient's recovery, for instance.

Some community hospitals are comparable to regional medical centers with major teaching programs in their expertise in performing certain procedures and are able to deliver their care at significantly lower prices. But if you or a family member needs treatment for a condition that could jeopardize your long-term health - or even your life - it might well be a good idea to explore with your doctor treatment alternatives by a team that is more specialized and experienced than what is available closer to home.

One excellent source of information about specialty medical centers in the United States is the annual survey, America's Best Hospitals, published by the magazine U.S. News & World Report. The study assesses the quality of care at major medical centers for 16 specialty fields, from AIDS to urology.

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Updated on October 8, 1995