Research role expands at community hospitals

Shift brings prestige, profits, but also fears over conflicts of interest


At Union Memorial Hospital in Baltimore, the medical director has pored over patient records to determine which antibiotics are to blame for a potentially fatal infection. In Ohio, physicians at Akron General Medical Center are experimenting with rats to determine whether a popular painkiller also slows the spread of cancerous cells. And in Los Angeles, doctors at Cedars Sinai Medical Center are teaching computers to interpret heart scans.

Across the country, tighter finances and tougher competition are prompting many community hospitals to move beyond their core business of administering tests and performing surgery. Increasingly, they are doing cutting-edge research that had been left to universities, drug companies and government laboratories.

"The classic paradigm of research is expanding," said Barbara V. Howard, president of the research arm of MedStar Health, a network of seven area hospitals that includes Union Memorial. "Hospitals like ours are taking an increasing role."

FOR THE RECORD - A Page 1A article yesterday about the expansion of research at community hospitals incorrectly reported the location of the Baylor Health Care System. It is in Dallas, Texas.
The Sun regrets the errors.

In addition to treating patients, community hospitals are studying experimental drugs, developing medical devices and investigating serious diseases.

They are also recruiting scientists, building laboratories and competing for prestigious research grants. Some are publishing papers in peer-reviewed journals and obtaining patents.

"It just enriches your ability to do high-quality medical care," said Margot LaPointe, medical director of research at Henry Ford Health System in Detroit, which has 71 scientists and a $56 million research budget for studying the treatment of prostate cancer with gene therapy, among other projects.

The work can also bolster a hospital's profits. At a time of heightened competition from other medical centers, research breakthroughs burnish a hospital's reputation, helping it attract physicians and patients. It also provides new sources of income to offset rising labor costs and lower Medicare payments.

Companies pay

Community medical centers are conducting some of the research on behalf of pharmaceutical companies, which pay for patients to participate in clinical trials testing new drugs and medical devices. As that work increases, ethicists and watchdogs worry about the possibility of conflicts of interest.

"If you think of it as philanthropy, it is not," said Frank Sloan, a professor of health economics at Duke University. "Some of it is public relations, and there's some money."

Community hospitals are distinct from those that are part of medical schools, such as Johns Hopkins Hospital and the University of Maryland Medical Center in Baltimore. The medical centers and regional networks aren't owned by any university, though they might employ residents from medical schools.

Nationwide, 120 health care systems conducting research independently. Most have done so for years as a condition of employing medical school residents, but administrators say that until recently, the work was nothing like the high-powered scientific work being done in academia, industry and government.

Typical is Baylor Health Care System in Houston. It established a research institute in 1984 but didn't begin seriously pursuing grants and projects until 2000, said Dr. Michael Ramsey, the institute's president.

Budget quintuples

Since then, the institute's budget has quintupled, to $50 million. It has 175 staff members, including an investigator hired from Stanford University to develop a lymphoma vaccine. Baylor also established a biotechnology company to develop cancer vaccines.

"Once the train gets rolling, you have to follow it," Ramsey said.

The research has helped Baylor attract top clinicians and has made the system more of a draw for patients, he said.

The Alliance of Independent Academic Medical Centers, a trade association of 52 hospitals that are not part of medical schools, does not keep statistics on the amount of research its members conduct.

Kimberly Pierce-Boggs, the group's executive director, said cutbacks in federal reimbursement and the pressures of managed care have forced independent hospitals to hone their research in ways that attract patients and to improve medical care and cut costs.

Dr. Robert P. Ferguson, medical director at Union Memorial, began analyzing patient records three years ago to find out whether certain antibiotics contributed to a colon infection that had proved fatal in several patients.

He recently directed physicians to use what he found to be the most effective drug, which he estimates could save the hospital $400,000 a year in costs for medical care that insurance companies won't cover.

"If we can come up with a solution to which antibiotic to prescribe over another, we would presumably save a lot of anguish for the patients and a lot of cost to the hospital," said Ferguson, who plans to present his findings at a conference in October.

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