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August 16, 2000

Managed Care Insurance and Use of Higher-Mortality Hospitals

Author Affiliations

Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(7):829-831. doi:10.1001/jama.284.7.827

To the Editor: In the study by Dr Erickson and colleagues,1 the effect of clinical urgency on choice of hospitals was not sufficiently examined. The timing of CABG is closely correlated to clinical severity2 and has a marked influence on the choice of hospital. In an emergency, patients are likely to be admitted to the facility nearest their place of residence. In terms of service provision management, clinical severity may, on the one hand, yield a priority rating (based on explicit criteria); on the other hand, it may determine the referral facility by taking into account bed availability and the fact that facility outcomes depend, among other things, on case mix severity and access procedure. For example, Showstack et al3 showed that lower-volume hospitals only had higher adjusted mortality rates for nonscheduled patients, while there was no such correlation for scheduled patients.

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