In a 15-year study of older Medicare patients, Yale School of Medicine researchers saw an estimated 20% drop in mortality, about 30% fewer hospitalizations, and 40% reduction in deaths after hospitalization.
While these results are encouraging, they should not lead to complacency, the researchers caution.
Published in the July 28 JAMA theme issue on Medicare and Medicaid at 50, the study took a comprehensive look at national trends in mortality, hospitalizations, outcomes, and expenditures from all causes from 1999 to 2013. The team, from the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital, analyzed data on 68,374,904 Medicare recipients 65 years of age or older from key demographic groups and geographic areas.
The team found that annual mortality rates from all causes across the Medicare population declined from 5.3% in 1999 to 4.5% in 2013. Among hospitalized fee-for-service beneficiaries, in-hospital mortality declined, as did 30-day and 1-year mortality.
"We are in the midst of a remarkable era of improvements in health and health care in America," said lead author Harlan M. Krumholz, M.D., the Harold H. Hines Jr. Professor of Medicine, professor of investigative medicine and of public health, and co-director of the Clinical Scholars Program. "This decline represents millions of hospitalizations averted and hundreds of thousands of deaths delayed."
"The news should give us reassurance about our current efforts, but not make us complacent. We should seek to continue our advances in technology, health behaviors and policies, and quality of care -- and seek to continue this remarkable trend," Krumholz added.
Krumholz and his team also found that the total number of hospitalizations for major surgery decreased over the course of the study. The average length of time spent in the hospital declined from 5 to 4 days, and the average inpatient costs per Medicare fee-for-service recipient declined from $3,290 to $2,801. The findings were consistent across geographic and demographic groups.
"Our findings provide an assessment of past performance and targets for future interventions," said Krumholz.
Other authors on the study included Sudhakar V. Nuti, Nicholas S. Downing, M.D., Sharon-Lise T. Normand, and Yun Wang.
The study was supported by a grant from the National Heart, Lung, and Blood Institute.
Citation: JAMA Vol. 314, Number 4 doi: 10.1001/jama.2015.8035 (July 28, 2015)