# Comparing hospitalization rates, outcomes, and treatment intensity for elderly patients across OECD countries

> **NIH NIH R01** · HARVARD MEDICAL SCHOOL · 2020 · $518,700

## Abstract

In 2011 the National Academy of Medicine convened a panel to explore the paradox of why the US spends
more on healthcare than other Organization of Economic Cooperation and Development (OECD) countries yet
has inferior outcomes. It concluded that “Data are simply lacking to fully understand the causal factors
responsible for each of the diseases and injuries that disproportionately affect the US population.” Although
aggregate measures of health systems performance such as life expectancy and infant mortality rates suggest
that US health care system performance lags, a limited number of direct comparisons of medical treatments
suggest that the US may have better outcomes than OECD peers for acute conditions including hip fracture
(HF) and acute myocardial infarction (AMI). Modestly improved US outcomes, however, come at the expense
of extraordinarily high utilization of cardiac catheterization for AMI and other costly procedures. Moreover,
disadvantaged populations in the US may fare worse than disadvantaged populations in other countries.
It is a convenient narrative to simply conclude that the US spends more and gets less from an underperforming
healthcare system. Yet, there may be a more nuanced story. Some research supports the notion that
differences in where money is spent (acute care vs. social services) might explain part of the differences in
health outcomes. Thus further rigorous research is needed to understand better the contributions of the health
care system to outcomes. We propose to update a disjointed, incomplete and outdated literature by
systematically studying patterns of utilization, outcomes, and treatment intensity for older adults with specific
acute conditions treated in wealthy countries with vastly different healthcare systems. Our research will inform
the debate about whether more intensive treatment practices in the US also lead to better outcomes.
The overarching objective of our study is to compare treatment for older adults from five OECD countries (US,
Canada, Netherlands, Israel and England) hospitalized with one of 5 carefully selected tracer conditions: hip
fracture (HF), acute myocardial infarction (AMI); ischemic stroke, elective aortic aneurysm repair (AAA), and
congestive heart failure (CHF). Our proposal has five specific aims that assess: (1) differences in the
epidemiology of the conditions; (2) differences in treatment intensity; (3) differences in outcomes, including
mortality at 90 days and one year; (4) differences after stratifying by socioeconomic status and overall health;
and (5) differential changes in treatment patterns over time. Our proposed work will provide a nuanced
understanding of the effectiveness of treatment approaches in the five countries and will provide insights into
the functioning of their health care systems. The scientific premise of our proposal is that granular information
is needed to inform the study of comparative health systems. In addition, the international collaborati...

## Key facts

- **NIH application ID:** 9962250
- **Project number:** 5R01AG058878-02
- **Recipient organization:** HARVARD MEDICAL SCHOOL
- **Principal Investigator:** Peter M Cram
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $518,700
- **Award type:** 5
- **Project period:** 2019-07-01 → 2025-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9962250

## Citation

> US National Institutes of Health, RePORTER application 9962250, Comparing hospitalization rates, outcomes, and treatment intensity for elderly patients across OECD countries (5R01AG058878-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9962250. Licensed CC0.

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