Comparing hospitalization rates, outcomes, and treatment intensity for elderly patients across OECD countries

2011年，美国国家医学科学院召集了一个小组，以探索美国为什么要花费 在医疗保健方面比其他经济合作与发展组织(OECD)国家更多 结果很差。报告的结论是：“完全缺乏数据来充分理解原因。 对每一种疾病和伤害负有责任，这些疾病和伤害对美国人口的影响不成比例。虽然 预期寿命和婴儿死亡率等卫生系统绩效的综合衡量标准表明 认为美国医疗体系的表现滞后，直接比较医疗治疗的数量有限 提示美国在治疗包括髋部骨折在内的急性疾病方面可能比OECD的同行有更好的结果 心力衰竭(HF)和急性心肌梗死(AMI)。然而，美国结果的适度改善是以牺牲为代价的 对于急性心肌梗死和其他昂贵的手术，心导管的使用率非常高。此外， 美国的弱势群体可能比其他国家的弱势群体境况更糟。 简单地说，美国从表现不佳的国家那里支出更多，获得更少，这是一种便利的叙事 医疗保健系统。然而，可能会有一个更微妙的故事。一些研究支持这样的观点： 钱花在哪里的差异(急性护理和社会服务)可能解释了 健康结果。因此，需要进一步进行严格的研究，以更好地了解健康的贡献 护理系统对结果的影响。我们建议通过以下方式更新不连贯、不完整和过时的文献 系统研究老年人对特定疾病的利用模式、结果和治疗强度 在医疗体系迥然不同的富裕国家，急性病得到了治疗。我们的研究将告诉我们 关于美国更密集的治疗实践是否也会带来更好的结果的辩论。 我们研究的主要目标是比较五个经合组织国家(美国、 加拿大、荷兰、以色列和英国)因5种精心挑选的示踪剂疾病之一入院治疗：髋关节 骨折(HF)、急性心肌梗死(AMI)、缺血性中风、择期主动脉瘤修补术(AAA)以及 充血性心力衰竭。我们的建议有五个具体目标来评估：(1) 疾病的流行病学；(2)治疗强度的差异；(3)结果的差异，包括 90天和一年的死亡率；(4)按社会经济地位和总体健康状况分层后的差异； 以及(5)治疗模式随时间的不同变化。我们提议的工作将提供一个细微差别 了解这五个国家的治疗方法的有效性，并将为 他们的医疗保健系统的运作。我们建议的科学前提是细粒度的信息 需要为比较卫生系统的研究提供信息。此外，国际合作， 我们为这项提案所形成的表格将作为开发研究方法和专业知识的基础 具有全国代表性的数据，以比较不同国家的医疗保健。

In 2011 the National Academy of Medicine convened a panel to explore the paradox of why the US spends more on healthcare than other Organization of Economic Cooperation and Development (OECD) countries yet has inferior outcomes. It concluded that “Data are simply lacking to fully understand the causal factors responsible for each of the diseases and injuries that disproportionately affect the US population.” Although aggregate measures of health systems performance such as life expectancy and infant mortality rates suggest that US health care system performance lags, a limited number of direct comparisons of medical treatments suggest that the US may have better outcomes than OECD peers for acute conditions including hip fracture (HF) and acute myocardial infarction (AMI). Modestly improved US outcomes, however, come at the expense of extraordinarily high utilization of cardiac catheterization for AMI and other costly procedures. Moreover, disadvantaged populations in the US may fare worse than disadvantaged populations in other countries. It is a convenient narrative to simply conclude that the US spends more and gets less from an underperforming healthcare system. Yet, there may be a more nuanced story. Some research supports the notion that differences in where money is spent (acute care vs. social services) might explain part of the differences in health outcomes. Thus further rigorous research is needed to understand better the contributions of the health care system to outcomes. We propose to update a disjointed, incomplete and outdated literature by systematically studying patterns of utilization, outcomes, and treatment intensity for older adults with specific acute conditions treated in wealthy countries with vastly different healthcare systems. Our research will inform the debate about whether more intensive treatment practices in the US also lead to better outcomes. The overarching objective of our study is to compare treatment for older adults from five OECD countries (US, Canada, Netherlands, Israel and England) hospitalized with one of 5 carefully selected tracer conditions: hip fracture (HF), acute myocardial infarction (AMI); ischemic stroke, elective aortic aneurysm repair (AAA), and congestive heart failure (CHF). Our proposal has five specific aims that assess: (1) differences in the epidemiology of the conditions; (2) differences in treatment intensity; (3) differences in outcomes, including mortality at 90 days and one year; (4) differences after stratifying by socioeconomic status and overall health; and (5) differential changes in treatment patterns over time. Our proposed work will provide a nuanced understanding of the effectiveness of treatment approaches in the five countries and will provide insights into the functioning of their health care systems. The scientific premise of our proposal is that granular information is needed to inform the study of comparative health systems. In addition, the international collaboration that we form for this proposal will serve as the basis for developing research methods and expertise in using nationally representative data to compare healthcare across countries.