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Comparing Outcomes and Costs of Medical Patients Treated at Major Teaching and Non-teaching Hospitals: A National Matched Analysis

  • Jeffrey H. SilberEmail author
  • Paul R. Rosenbaum
  • Bijan A. Niknam
  • Richard N. Ross
  • Joseph G. Reiter
  • Alexander S. Hill
  • Lauren L. Hochman
  • Sydney E. Brown
  • Alexander F. Arriaga
  • Lee A. Fleisher
Original Research

Abstract

Background

Teaching hospitals typically pioneer investment in new technology and cultivate workforce characteristics generally associated with better quality, but the value of this extra investment is unclear.

Objective

Compare outcomes and costs between major teaching and non-teaching hospitals by closely matching on patient characteristics.

Design

Medicare patients at 339 major teaching hospitals (resident-to-bed (RTB) ratios ≥ 0.25); matched patient controls from 2439 non-teaching hospitals (RTB ratios < 0.05).

Participants

Forty-three thousand nine hundred ninety pairs of patients (one from a major teaching hospital and one from a non-teaching hospital) admitted for acute myocardial infarction (AMI), 84,985 pairs admitted for heart failure (HF), and 74,947 pairs admitted for pneumonia (PNA).

Exposure

Treatment at major teaching hospitals versus non-teaching hospitals.

Main Measures

Thirty-day all-cause mortality, readmissions, ICU utilization, costs, payments, and value expressed as extra cost for a 1% improvement in survival.

Key Results

Thirty-day mortality was lower in teaching than non-teaching hospitals (10.7% versus 12.0%, difference = − 1.3%, P < 0.0001). The paired cost difference (teaching − non-teaching) was $273 (P < 0.0001), yielding $211 per 1% mortality improvement. For the quintile of pairs with highest risk on admission, mortality differences were larger (24.6% versus 27.6%, difference = − 3.0%, P < 0.0001), and paired cost difference = $1289 (P < 0.0001), yielding $427 per 1% mortality improvement at 30 days. Readmissions and ICU utilization were lower in teaching hospitals (both P < 0.0001), but length of stay was longer (5.5 versus 5.1 days, P < 0.0001). Finally, individual results for AMI, HF, and PNA showed similar findings as in the combined results.

Conclusions and Relevance

Among Medicare patients admitted for common medical conditions, as admission risk of mortality increased, the absolute mortality benefit of treatment at teaching hospitals also increased, though accompanied by marginally higher cost. Major teaching hospitals appear to return good value for the extra resources used.

KEY WORDS

Medicare value teaching hospitals mortality cost 

Notes

Acknowledgments

We thank Traci Frank, AA; Kathryn Yucha, MSN, RN; and Sujatha Changolkar (Center for Outcomes Research, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA) for their assistance with this research.

Compliance with Ethical Standards

Conflict of Interest

This research was funded by a grant from the Association of American Medical Colleges (AAMC) to study differences between teaching and non-teaching hospitals on outcomes, costs and value. AAMC had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; or decision to submit the manuscript for publication.

The authors declare that the Children’s Hospital of Philadelphia (CHOP) and the University of Pennsylvania (PENN) received a research grant from the Association of American Medical Colleges (AAMC) which, in turn, provided partial salary support for some investigators.

Supplementary material

11606_2019_5449_MOESM1_ESM.docx (593 kb)
ESM 1 (DOCX 416 kb).

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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Jeffrey H. Silber
    • 1
    • 2
    • 3
    • 4
    • 5
    Email author
  • Paul R. Rosenbaum
    • 5
    • 6
  • Bijan A. Niknam
    • 1
  • Richard N. Ross
    • 1
  • Joseph G. Reiter
    • 1
  • Alexander S. Hill
    • 1
  • Lauren L. Hochman
    • 1
  • Sydney E. Brown
    • 3
  • Alexander F. Arriaga
    • 3
    • 7
    • 8
  • Lee A. Fleisher
    • 3
    • 5
    • 8
  1. 1.Center for Outcomes Research, Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.TheDepartment of PediatricsThe University of Pennsylvania Perelman School of MedicinePhiladelphiaUSA
  3. 3.Department of Anesthesiology and Critical CareThe University of Pennsylvania Perelman School of MedicinePhiladelphiaUSA
  4. 4.Department of Health Care Management, Wharton SchoolUniversity of PennsylvaniaPhiladelphiaUSA
  5. 5.Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaUSA
  6. 6.Department of Statistics, Wharton SchoolUniversity of PennsylvaniaPhiladelphiaUSA
  7. 7.Department of Anesthesiology, Perioperative, and Pain MedicineBrigham and Women’s HospitalBostonUSA
  8. 8.Center for Perioperative Outcomes Research and TransformationUniversity of PennsylvaniaPhiladelphiaUSA

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