Document Detail

Severity-adjusted mortality and length of stay in teaching and nonteaching hospitals. Results of a regional study.
MedLine Citation:
PMID:  9256223     Owner:  NLM     Status:  MEDLINE    
CONTEXT: Major teaching hospitals are perceived as being more expensive than other hospitals and, thus, unattractive to managed care. However, little empirical data exist about their relative quality and efficiency. The current study compared severity-adjusted mortality and length of stay (LOS) in teaching and nonteaching hospitals.
DESIGN: Retrospective cohort study.
SETTING: Thirty hospitals in northeast Ohio.
PATIENTS: A total of 89851 consecutive eligible patients discharged in 1991 through 1993 with myocardial infarction, congestive heart failure, obstructive airway disease, gastrointestinal hemorrhage, pneumonia, or stroke.
MAIN OUTCOME MEASURES: In-hospital mortality and LOS of patients in major teaching (n=5), minor teaching (n=6), and nonteaching (n=19) hospitals were adjusted for admission severity of illness using multivariable models based on demographic and clinical data abstracted from patients' medical records.
RESULTS: The adjusted odds of death was 19% lower (95% confidence interval [CI], 2%-34%; P=.03) for patients in major teaching hospitals compared with non-teaching hospitals but was similar (95% CI, 7% lower to 28% higher; P=.28) for patients in minor teaching hospitals. The findings were generally consistent in analyses stratified according to diagnosis, age, race, predicted risk of death, and other covariates. In addition, risk-adjusted LOS was 9% lower (95% CI, 8%-10%; P<.001) among patients in major teaching hospitals relative to nonteaching hospitals but was similar (95% CI, 2% lower to 11% higher; P=.17) in minor teaching hospitals. Major teaching hospitals also cared for higher proportions of nonwhite and poorly insured patients.
CONCLUSIONS: Risk-adjusted mortality and LOS were lower for patients in major teaching hospitals than for patients in minor teaching and nonteaching hospitals. If generalizable to other regions, the results provide evidence that hospital performance, as assessed by 2 commonly used indicators, may be higher in major teaching hospitals. These findings are noteworthy at a time when the viability of many major teaching hospitals is threatened by powerful health care market forces and by potential changes in federal financing of graduate medical education.
G E Rosenthal; D L Harper; L M Quinn; G S Cooper
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  JAMA     Volume:  278     ISSN:  0098-7484     ISO Abbreviation:  JAMA     Publication Date:  1997 Aug 
Date Detail:
Created Date:  1997-08-21     Completed Date:  1997-08-21     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  485-90     Citation Subset:  AIM; IM    
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MeSH Terms
Data Collection
Diagnosis-Related Groups
Economic Competition
Efficiency, Organizational
Health Care Surveys
Hospital Mortality*
Hospitals, Teaching / standards,  statistics & numerical data*,  utilization
Length of Stay / statistics & numerical data*
Multivariate Analysis
Outcome and Process Assessment (Health Care)*
ROC Curve
Regression Analysis
Retrospective Studies
Socioeconomic Factors
Comment In:
JAMA. 1997 Dec 17;278(23):2062; author reply 2063   [PMID:  9403412 ]
JAMA. 1997 Aug 13;278(6):520   [PMID:  9256230 ]
JAMA. 1997 Dec 17;278(23):2062-3   [PMID:  9403413 ]
JAMA. 1997 Dec 17;278(23):2062; author reply 2063   [PMID:  9403411 ]

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