Patients may fare better in major
teaching hospitals
Patients treated at a major teaching hospital
for major illnesses such as heart attacks and strokes may have a lower
risk of death and a shorter hospital stay than those treated at nonteaching
hospitals, according to an article in the Aug. 13 issue of The Journal
of the American Medical Association (JAMA).
Gary E. Rosenthal, M.D., of the Case Western Reserve University School of Medicine, Cleveland, Ohio, and colleagues studied records of nearly 90,000 patients in northeastern Ohio who were discharged from hospitals with a diagnosis of stroke, heart attack, congestive heart failure, pneumonia, gastrointestinal bleeding or obstructive airway disease. The study looked at 30 hospitals: 19 nonteaching hospitals; six minor teaching hospitals; and five major teaching hospitals. The study compared two widely used measurements in evaluating hospitalizations--mortality and length of stay in the hospital. Mortality figures were adjusted for the patients' risk of death based on their diseases.
The authors write: "We found that the risk of death was 19 percent lower in major teaching hospitals, compared with nonteaching hospitals, and that length of stay was nearly 10 percent lower. In contrast, mortality and length of stay were generally similar in minor teaching hospitals, indicating that the potential advantages of major teaching hospitals is probably not related to teaching status, per se, but to other aspects of the organization and delivery of hospital care."
They authors explain that major teaching hospitals often struggle because they are facing a complex social mission to provide medical education, to sponsor basic and applied research, and to offer a broad spectrum of clinical services, especially to indigent populations. Their challenge is to do this in a cost-effective manner so they may compete with community hospitals for managed care contracts.
They write: "If, as many proponents claim, major teaching hospitals provided superior care that led to better patient outcomes, a stronger rationale might exist for purchasers to support their use. Moreover, while it is often assumed by purchasers that the higher cost of major teaching hospitals stems in large measure from inefficiencies and overutilization of tests and procedures, few studies have separated the cost of care from efficiency or actual resource use."