Thu. Dec 3rd, 2020

If you are suffering from a Serious chronic disease, or you need major but elective surgery: are you 90 km from the road below the superior hospital or the major medical center? See what specialists in lung disease, heart conditions, cancer and orthopedics say when your local hospital is a good option Regular process And when Find the next level of care From an educational medical center, a major hospital system or a specialized center.

complete Hip replacement And Knee space Are one of the most commonly performed surgeries in the US and can be performed in a world renowned versus community hospital Orthopedics facility, Dr. Says Alexandra Page, an orthopedic surgeon in a private practice in San Diego. Access is a big part of the equation, Page says – a highly acclaimed hospital center is no help for a patient if it is inaccessible due to distance or insurance coverage issues.

When high-tech treatments available at only a few centers are considered instead of standard medicine, Page says, you should avoid being the first patient to undergo the procedure – but never be the last to do so. Be prepared to move forward as the practice gets older, she advises. However, she says, “Some other things that look sexy and attractive that create buzz often don’t make a difference.” For example, with robot joint replacement, she says that the research literature is “the best.”

But there are times when specialty centers make sense. With musculoskeletal tumors, like breast cancer that spreads to the bones, it is important that a specialist handles it, Page says. Similarly, community hospitals may not have the resources for complex joint surgery such as complex modifications for deep infections or percutaneous implants. Orthopedic surgeons know when to refer patients, if their facility often does not have adequate or specialized equipment available.

“In commonly occurring diseases, and commonly occurring problems,” says Dr. Otis Brawley, Chief Medical Officer of Otis Brawley, we have found great data to show that a community hospital and community physician are doing those things. Can do well. “American Cancer Society.” And indeed, sometimes, tertiary care can work better than a facility. ”

For example, says Brawley, a woman with early stage breast cancer achieves the standard Chemotherapy Adriamycin and Cytoxan can improve locally. “If you go to a large university hospital or cancer center that employs 80 chemotherapy nurses – they give it, but they can’t give it often,” Bravale says. Instead, those nurses are giving many types of chemotherapy to many more patients.

Clinical study There is an indication that a hospital is keeping up with the latest cancer research. “Many of your local hospitals actually participate in National Cancer Institute clinical trials,” Bravelle says. Community hospitals often get patients faster through x-rays and other tests and spend less time to see physicians, says Brawley, who practices at Emory Winship Cancer Institute, a major referral center in Atlanta.

High-level hospitals become more important as care becomes more complex, Bravely says. For example, lung cancer requiring chest surgery, consider a referral facility. In addition, “tertiary care centers are much better at caring for common, uncommon cancers,” he says. With some complicated spinal tumors, a Major Cancer Centers Are indicated.

Broly says Proton beam radiation – An expensive therapy given in a handful of US centers – is supported by evidence only in cases of pediatric brain tumors and for adults, as a better option with tumors in the sellar region of the brain, as it is nearby. Prevents damage to neurological structures.

For patients with a lung condition such as Prolonged lung obstruction“It is important to find a local pulmonologist as well as a primary care physician,” says Dr. Albert Rizzo, senior medical advisor at the American Lung Association. These providers can determine whether the community hospital can meet the needs of COPD patients, and when to See patients in specialized centers, Rizzo, who heads pulmonary and critical care medicine at the Christiana Care Health System located in Wilmington, Delaware.

Community hospitals can have excellent medical teams, Rizzo emphasizes, giving physicians an extensive background, including experience in educational centers and research. However, he says, there should be a discussion of what happens next Asthma Or COPD patients have been through a step-wise approach to medical treatment, but suffer from worsening or unstable disease with flare.

With referrals to specialized centers, patients can seek another opinion to ensure that their treatment is appropriate and their diagnosis is correct, Rizzo says. An academic center may be the best bet for a clinical trial that provides access to new drugs. Some lung procedures – such as surgical or nonsurgical volume-reduction techniques for patients with COPD – will be performed in a referral center rather than in a community hospital.

When people move to a new area, they should look in advance at local health care options, Drs. Andrew Freeman, who serves on the Patient-Centered Care Committee of the American College of Cardiology. If you have a chronic condition like heart failure, Where will you goThe What is a good place for normal cardiovascular procedures?

“The vast majority of stent and bypass surgeries are performed on a more elective or at least semi-elective basis – it makes sense to do a little research and homework,” says Freeman. This includes meeting the surgeon, asking for references, and reading two and reading online.

For programs like Cardiac rehabilitation, A suburban hospital might be better known as Heart center. “The community hospital has a worse rape, but in many situations, the community hospital has more physical facilities than the old academic hospital,” says Freeman, director of clinical cardiology at National Judity Health in Denver. “I always tell people that community hospitals can have some of the most talented people, the best results – sometimes even better than in educational hospitals.”

On the other hand, Freeman says, “If you have a complex situation that is not the norm, then going to a specialized center, which we call either tertiary or quadrennial referral center – usually educational hospital – makes sense. . ” These centers can excel in very precise fields, he says. The Philadelphia area where he trained was full of academic learning centers: “Some were fantastic for heart transplants, and some were brilliant for TAVR. [transcatheter aortic valve replacement], And some were superb for bypass surgery. ”

Like processes heart transplant Clearly fall into the category of specialty-centers. Still, Freeman says, “an overwhelming amount of evidence suggests that people who are undergoing heart transplant or valve transplant or bypass surgery – do better when they have family and support and caregivers.” ”

“People identify a hospital with their community,” Dr. Says John Combes, senior vice president and chief medical officer of the American Hospital Association. “In some smaller cities and certainly more rural areas, it may be the only hospital within 25 miles or more. In major metropolitan areas, sometimes an educational medical center is your community hospital.” He said that the most important thing is for the patients where their best support systems – families and communities are available. So traveling for a big process may not be the best.

For overall performance and objective criteria on specific procedures, the combination only advises patients to examine outcomes on Medicare Hospital comparison but Physician ComparisonIt may be better to turn to a major medical center, teaching hospital or specialty center if you have a very rare or unclear diagnosis, he says. Or consider a center of excellence around your particular disease if you are seeking breakthrough treatment and related technology. There is another option Search for magnet hospitalsRecognized by the American Nurses Credentialing Center for Nursing Excellence and Outstanding Patient Care.

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