Do Patients Plus Clinical Trials Equal Better Care?

Interesting question: Is there a relationship between the quality of patient care that a hospital delivers and the hospital's degree of participation in clinical trials? Maybe so, suggests a new study in the Archives of Internal Medicine.

The study looked at 174,000 patients with serious heart problems. All were admitted between 2001 and mid-2006 to one of 494 U.S. hospitals that had agreed to monitor their care to see how faithfully they were given four drugs (such as aspirin and beta-blockers) within the first 24 hours and five (such as a statin) prior to discharge. To be monitored, patients had to be enrolled in the initiative. Only 2.6 percent of the patients agreed (few clinical trials boast high enrollment rates). Some hospitals signed up a fair number of patients. Others didn't enroll a single one.

When the authors of the Archives study compared each hospital's percentage of eligible patients who signed up with how well the hospital adhered to the drug regimen, they found that the greater the participation, the better the medication compliance. And the higher the participation rate, the lower the death rate. Mortality was 5.9 percent in hospitals that didn't enroll any patients, 4.4 percent for hospitals that enrolled some patients, and 3.5 percent for hospitals that enrolled a larger number.

Why? The study's authors mention various possibilities, among them that the kinds of medical professionals who run clinical trials tend to be high-profile types who are likelier to find out about new drugs and devices, to talk with colleagues who are similarly galvanized, and to work positive results of their trials into patient care.

It's only one study, and it focuses on a specific category of patients. But it is intriguing. If borne out by other studies, such results could provide an argument for stirring clinical trial participation into the methodology soup ladled out annually into "America's Best Hospitals" rankings. We'll be watching.