Efficiency, not more doctors, is the prescription for aging population

base to examine the experience of chronically-ill people who received most of their medical care at academic medical centers, the researchers calculated the physician workforce inputs per patient during their last 6 months of life. Their analysis found that the full-time equivalent physician input per 1,000 chronically-ill patients varied by a factor of five, from about 6 per 1,000 to almost 30 per 1,000.

For example, patients treated at the Mayo Clinic used fewer than 9 physicians on average, among the lowest in the country. By contrast, patients treated at New York University Medical Center, another medical school-affiliated facility, used 28.3 physicians per 1,000 in the 6 months before death.

"Both of these models can't be 'the best'" way to provide medical care to the chronically ill," Goodman said. "We believe that, in fact, less is more, and that quality of care, rather than quantity, is the critical factor"

The research focuses on the management of severe chronic illness because it is the area where health care resources are most heavily used--about half of Medicare's budget goes to the care of chronically-ill Americans. Additionally, the need for such management is expected to increase as the population ages and baby boomers acquire a growing number of ailments such as Type II diabetes, congestive heart failure, and chronic obstructive pulmonary disease.

Prior studies by CECS, published in the Dartmouth Atlas of Health Care, have demonstrated that in some parts of the country, people with severe chronic illnesses receive more physician care in visits, hospitalizations, and procedures than people who live in areas with fewer physicians per capita. But contrary to popular belief, patients who have more doctor visits and treatments do not realize a benefit. Indeed, evidence shows they may actually be harmed by unnecessary medical care, Goodman said. If all medical practices adopted the practice style and resource use of ef

Contact: Andy Nordhoff
Dartmouth Medical School

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