In an analysis that included more than 21 million Medicare discharges, admission to a major teaching hospital was associated with a lower overall 30-day risk of death compared with admission to a nonteaching hospital, according to a study published by JAMA.
Academic medical centers (AMCs) are often considered more expensive than community hospitals and some insurers have excluded AMCs from their networks in an attempt to control costs, assuming that quality is comparable. Because evaluating the value of medical care requires consideration of quality as well as cost, understanding whether teaching hospitals provide better care is critical. The seminal studies on this topic are 18 to 25 years old, and it is unclear whether those findings persist in the contemporary health care environment.
Ashish K. Jha, M.D., M.P.H., of the Harvard T.H. Chan School of Public Health, Boston, and colleagues used national Medicare data to compare mortality rates in U.S. teaching and nonteaching hospitals for all hospitalizations and for common medical and surgical conditions among Medicare beneficiaries 65 years and older.
The sample consisted of 21.4 million total hospitalizations at 4,483 hospitals, of which 250 (5.6 percent) were major teaching (members of the Council of Teaching Hospitals), 894 (20 percent) were minor teaching (other hospitals with medical school affiliation), and 3,339 (74 percent) were nonteaching hospitals. After adjusting for patient and hospital characteristics, 30-day mortality was 8.3 percent at major teaching, 9.2 percent at minor teaching, and 9.5 percent at nonteaching hospitals.
After stratifying by hospital size, large (400 beds) and medium-sized (100-399 beds) major teaching hospitals had lower adjusted overall 30-day mortality relative to similarly-sized nonteaching hospitals. Among small (99 beds or less) hospitals, minor teaching hospitals had lower overall 30-day mortality relative to nonteaching hospitals.
"Further study is needed to understand the reasons for these differences," the authors write.
Several limitations of the study are noted in the article, including that it examined mortality rates for the Medicare fee-for-service population, and thus it was not possible to determine whether these findings are generalizable to nonelderly populations.
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(doi:10.1001/jama.2017.5702)
Editor's Note: This study was funded by the Association of American Medical Colleges. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
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JAMA