Data from cardiac patients supports ban on specialist hospitals in the US

In 2003 the US government put a temporary moratorium on the development of specialist hospitals that are partly owned by the doctors using them. Officials were responding to concerns that specialist hospitals cherry picked healthy patients having low risk but lucrative procedures. A retrospective analysis of Medicare data from 69 011 coronary patients supports this view. Those who had their percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in specialist cardiac hospitals were healthier (fewer comorbidities such as diabetes), better off (from neighbourhoods with a higher mean income), and more likely to be classed as “elective” than patients who had their procedure in general hospitals. Predictably, crude death rates were lower in specialist hospitals (2.1% v 3.1% for PCI and 5.0% v 5.8% for CABG; P < 0.001 for each comparison), but the differences disappeared once the data had been adjusted for patients' characteristics and for the higher patient volumes in specialist hospitals (adjusted odds ratio for death 1.05, 95% CI 0.83 to 1.32 for PCI; 0.91, 0.74 to 1.11 for CABG).

A report commissioned by Congress has also reported recently (pp 1405-7) that specialist hospitals owned by doctors tend to treat healthier patients who have more “profitable” diseases than do general hospitals. The report, which was compiled by the Medicare Payment Advisory Commission (MedPAC), recommended that Congress extend the ban on specialist hospitals until January 2007.

New England Journal of Medicine 2005;352: 1454-62

Suicide screening is unlikely to harm American high school students

Preventing suicide in young people is moving up the political and social agenda in the United States, and screening high school students is an increasingly important part of the strategy. There's some evidence that screening for mental health problems can work, but experts still worry that discussing suicide with teenagers might encourage them to try it.

The first randomised …