Relationship of Hospital Teaching Status With Quality of Care and Mortality for Medicare Patients With Acute MI

Allison, Jeroan J.; Kiefe, Catarina I.; Weissman, Norman; Person, Sharina D.; Rousculp, Matthew D.; Canto, John G.; Bae, Sejong; Williams, O. Dale; Farmer, Robert; Centor, Robert M.

doi:10.1001/jama.284.10.1256

Cited by 302 publications

(203 citation statements)

References 50 publications

(31 reference statements)

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“…13 Teaching status and its relationship to quality of care and outcomes have been examined across illnesses and procedures. 14 Many of these studies suggest that teaching hospitals have more favorable clinical outcomes. Levels of expertise and staffing may be an underlying explanation for the observed volume-outcome link; this could be modified to improve outcomes in low-volume hospitals.…”

Section: Discussion and Policy Implicationsmentioning

confidence: 99%

Volume Thresholds And Hospital Characteristics In The United States

Elixhauser¹,

Steiner²,

Fraser³

2003

Health Affairs

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Procedure volume has been used as a proxy for quality and recommended as a basis for hospital referrals. We studied the volume, mortality, and associated hospital and staffing characteristics of ten complex procedures in U.S. hospitals using the 2000 HCUP Nationwide Inpatient Sample. Although the majority of patients had their procedures performed in high-volume hospitals, for seven procedures, more than three-fourths of hospitals would be considered low-volume. Unadjusted mortality rates were significantly higher at low-volume hospitals for five procedures. Low-volume hospitals also tended to have lower mean numbers of residents and RNs. However, for two procedures, low-volume hospitals had RN and resident staffing equal to or higher than those of high-volume hospitals, and the unadjusted mortality rates were no different. Inc r e a se d c o nc e r n a b o u t pat i e n t s a f e t y in the hospital has brought renewed research and policy attention to a body of research linking mortality to the volume of inpatient procedures performed. Two recent literature reviews concluded that for certain complex and high-technology procedures, hospitals that perform more than a threshold number have significantly lower mortality than do hospitals where fewer procedures are performed. 1 Volume threshold levels have been recommended as the basis for evidence-based referrals, and a recent study concluded that in the absence of other information on quality of care, volume of procedures is a reasonable standard for selecting hospitals. 2 It is not clear how many people or hospitals would be affected by volume-based referrals, because much of the research has not provided national baseline information. Adams Dudley and colleagues used California data to estimate the impact of volume-based referrals. 3 John Birkmeyer and colleagues focused on Medicare patients. 4 In addition, past research does not provide much insight on why the link between volume and outcomes exists. Given that some low-volume hospitals

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Section: Discussion and Policy Implicationsmentioning

confidence: 99%

Volume Thresholds And Hospital Characteristics In The United States

Elixhauser¹,

Steiner²,

Fraser³

2003

Health Affairs

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“…[1][2][3][4] Previously published reports have found that, despite substantial differences in case mix, being admitted to a teaching hospital is associated with reduced morbidity and risk-adjusted mortality for various conditions compared with receiving care delivered at a nonacademic hospital. 2,[5][6][7][8][9][10][11][12][13] For example, among 248 major teaching, minor teaching, and nonteaching hospitals in New York state, Polanczyk et al found that major teaching hospital status was an important determinant of outcomes in patients hospitalized with myocardial infarction, heart failure, or stroke. 1 Some studies have noted that the high cost of care at teaching hospitals may offset these potential benefits.…”

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confidence: 99%

Comparison of resource utilization and clinical outcomes between teaching and nonteaching medical services

Khaliq

Huang

Ganti

et al. 2007

Journal of Hospital Medicine

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PURPOSE:To compare the resource utilization and clinical outcomes of medical care delivered on general internal medicine inpatient services at teaching and nonteaching services at an academic hospital. METHODS:From February to October 2002, 2189 patients admitted to a 450-bed university-affiliated community hospital were assigned either to a resident-staffed teaching service (n ϭ 1637) or to a hospitalist-or clinic-based internist nonteaching service (n ϭ 552). We compared total hospital costs per patient, length of hospital stay (LOS), hospital readmission within 30 days, in-hospital mortality, and costs for pharmacy, laboratory, radiology, and others between teaching and nonteaching services. RESULTS:Care on a teaching service was not associated with increased overall patient care costs ($5572 vs. $5576; P ϭ .99), LOS (4.92 days vs. 5.10 days; P ϭ .43), readmission rate (12.3% vs. 10.3%; P ϭ .21), or in-hospital mortality (3.7% vs. 4.5%; P ϭ .40). Mean laboratory and radiology costs were higher on the teaching service, but costs for the pharmacy and for speech therapy, occupational therapy, physical therapy, respiratory therapy, pulmonary function testing, and GI endoscopy procedures were not statistically different between the 2 services, and residents did not order more tests or procedures. Case mix and illness severity, as reflected by the distribution of the most frequent DRGs and mean number of secondary diagnoses per patient and DRG-specific LOS, were similar on the 2 services. CONCLUSIONS:

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“…Allison and colleagues demonstrated an improved quality of care and lower mortality rate in patients treated at major academic institutions after acute myocardial infarction. 19 Similarly, Polanczyk and colleagues found lower heart failure, myocardial infarction and stroke-adjusted mortality rates in major academic institutions. 21 These findings are highly valuable given that several authors have questioned the overall value of academic institutions and impact of academic affiliation on rc outcomes support continued investment in funds required to run these institutions.…”

Section: Discussionmentioning

confidence: 93%

“…For example, higher quality of care measures, [18][19][20] and lower complication and mortality rates 18,19,[21][22][23][24] were observed in patients treated at academic institutions. On the other hand, others have also reported no difference or worse outcomes at academic institutions.…”

Section: Discussionmentioning

confidence: 99%

Impact of academic affiliation on radical cystectomy outcomes in

Bianchi¹,

Trinh

Sun

et al. 2013

CUAJ

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Background: The objective of this study was to examine the rates of blood transfusions, prolonged length of stay, intraoperative and postoperative complications, as well as in-hospital mortality, stratified according to institutional academic status in patients undergoing radical cystectomy (RC). Methods: Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS), we focused on patients in whom RC was performed between 1998 and 2007. Multivariable logistic regression analyses were fitted to predict the likelihood of blood transfusions, prolonged length of stay, intraoperative and postoperative complications, and in-hospital mortality. Covariates included age, race, gender, Charlson Comorbidity Index (CCI), hospital region, insurance status, annual hospital caseload (AHC), year of surgery and urinary diversion. Results: Overall, 12 262 patients underwent RC. Of those, 7892 (64.4%) were from academic institutions. Patients treated at academic institutions were younger and healthier at baseline (all p < 0.001). RCs performed at academic institutions were associated with fewer postoperative complications (28.8% vs. 32.9%, p < 0.001), shorter length of stay (54.0% vs. 56.2%, p = 0.02) and lower in-hospital mortality rates (2.1 vs. 3.0%, p = 0.002). In multivariable analyses, patients who underwent RC at an academic hospital were 12% less likely to succumb to postoperative complications (odds ratio=0.88, p = 0.003). Interpretation: Even after adjusting for AHC, RCs performed at academic institutions are associated with better postoperative outcomes than RCs performed at non-academic institutions. From a public health prospective, performing RCs at academic institutions may help reduce costs associated with the management of complications and prolonged length of stay.

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Relationship of Hospital Teaching Status With Quality of Care and Mortality for Medicare Patients With Acute MI

Abstract: In this study of elderly patients with AMI, admission to a teaching hospital was associated with better quality of care based on 3 of 4 quality indicators and lower mortality. JAMA. 2000;284:1256-1262

Cited by 302 publications

References 50 publications

Volume Thresholds And Hospital Characteristics In The United States

Volume Thresholds And Hospital Characteristics In The United States

Comparison of resource utilization and clinical outcomes between teaching and nonteaching medical services

Impact of academic affiliation on radical cystectomy outcomes in

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