• Kyle H Sheetz, Justin B Dimick, and Amir A Ghaferi.
• Department of Surgery, University of Michigan, Ann Arbor.
• JAMA Surg. 2014 Dec 1;149(12):1254-9.

ImportanceHospitals' care intensity varies widely across the United States. Payers and policy makers have become focused on promoting quality, low-cost, efficient health care.ObjectiveTo evaluate whether increased hospital care intensity (HCI) is associated with improved outcomes following major surgery.Design, Setting, And ParticipantsUsing 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.ExposureThe HCI Index, which is validated and publicly available through the Dartmouth Atlas of Healthcare.Main Outcomes And MeasuresRisk- and reliability-adjusted mortality, major complication, and failure-to-rescue rates.ResultsHospital 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 RelevanceFailure-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.

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