Advertisement

Hospital outcomes in major teaching, minor teaching, and nonteaching hospitals in New York state

  • Carı́si A Polanczyk
    Affiliations
    Heart Failure and Cardiac Transplantation Unit (CAP, AL, MC, GWD, TGD), Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
    Search for articles by this author
  • Anthereca Lane
    Affiliations
    Heart Failure and Cardiac Transplantation Unit (CAP, AL, MC, GWD, TGD), Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
    Search for articles by this author
  • Michelle Coburn
    Affiliations
    Heart Failure and Cardiac Transplantation Unit (CAP, AL, MC, GWD, TGD), Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
    Search for articles by this author
  • Edward F Philbin
    Affiliations
    Section of Heart Failure and Heart Transplantation (EFP), Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, Michigan, USA
    Search for articles by this author
  • G.William Dec
    Affiliations
    Heart Failure and Cardiac Transplantation Unit (CAP, AL, MC, GWD, TGD), Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
    Search for articles by this author
  • Thomas G DiSalvo
    Correspondence
    Requests for reprints should be addressed to Thomas G. DiSalvo, MD, MPH, MGH Heart Failure Center – Bigelow 628, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114, USA
    Affiliations
    Heart Failure and Cardiac Transplantation Unit (CAP, AL, MC, GWD, TGD), Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
    Search for articles by this author

      Abstract

      Purpose

      The possible benefit that hospital teaching status may confer in the care of patients with cardiovascular disease is unknown. Our purpose was to determine the effect of hospital teaching status on in-hospital mortality, use of invasive procedures, length of stay, and charges in patients with myocardial infarction, heart failure, or stroke.

      Subjects and methods

      We analyzed a New York State hospital administrative database containing information on 388 964 consecutive patients who had been admitted with heart failure (n = 173 799), myocardial infarction (n = 121 209), or stroke (n = 93 956) from 1993 to 1995. We classified the 248 participating acute care hospitals by teaching status (major, minor, nonteaching). The primary outcomes were standardized in-hospital mortality ratios, defined as the ratio of observed to predicted mortality.

      Results

      Standardized in-hospital mortality ratios were significantly lower in major teaching hospitals (0.976 for heart failure, 0.945 for myocardial infarction, 0.958 for stroke) than in nonteaching hospitals (1.01 for heart failure, 1.01 for myocardial infarction, 0.995 for stroke). Standardized in-hospital mortality ratios were significantly higher for patients with stroke (1.06) but not heart failure (1.0) or myocardial infarction (1.06) in minor teaching hospitals than in nonteaching hospitals. Compared with nonteaching hospitals, use of invasive cardiac procedures and adjusted hospital charges were significantly greater in major and minor teaching hospitals for all three conditions. The adjusted length of stay was also shorter for myocardial infarction in major teaching hospitals and longer for stroke in minor teaching hospitals.

      Conclusion

      Major teaching hospital status was an important determinant of outcomes in patients hospitalized with myocardial infarction, heart failure, or stroke in New York State.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hartz A.J
        • Krakauer H
        • Kuhn E.M
        • et al.
        Hospital characteristics and mortality rates.
        N Engl J Med. 1989; 321: 1720-1725
        • Rosenthal G
        • Shah A
        • Way L
        • et al.
        Variations in standardized hospital mortality rates for six common medical diagnoses.
        Med Care. 1998; 36: 955-964
        • Keeler E
        • Rubenstein L
        • Kahn K
        • et al.
        Hospital characteristics and quality of care.
        JAMA. 1992; 268: 1709-1714
        • Ayanian J
        • Weissman J.S
        • Chasan-Taber S
        • et al.
        Quality of care for two common illnesses in teaching and nonteaching hospitals.
        Health Aff (Millwood). 1998; 17: 194-205
        • Hofer T
        • Hayward R
        Identifying poor-quality hospitals.
        Med Care. 1996; 34: 737-753
        • Epstein A
        US teaching hospitals in the evolving health care system.
        JAMA. 1995; 273: 1203-1207
      1. American Hospital Association Statistics. 1997
        • Deyo R.A
        • Cherkin C.K
        • Ciol M.A
        Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.
        J Clin Epidemiol. 1993; 46: 1075-1079
        • Charlson M.E
        • Pompei P
        • Ales K.L
        • MacKenzie R
        A new method of classifying prognostic comorbidity in longitudinal studies.
        J Chron Dis. 1987; 40: 373-383
        • Ghali W.A
        • Hall R.E
        • Rosen A.K
        • et al.
        Searching for an improved clinical comorbidity index for use with ICD-9-CM administrative data.
        J Clin Epidemiol. 1996; 49: 273-278
        • Polanczyk C
        • Rohde L
        • Philbin E
        • et al.
        A new case mix adjustment index for hospital mortality among patients with congestive heart failure.
        Med Care. 1998; 36: 1489-1499
        • Chen J
        • Radford M
        • Wang Y
        • et al.
        Do “America’s Best Hospitals” perform better for acute myocardial infarction?.
        N Engl J Med. 1999; 340: 286-292
        • Thiemann D
        • Coresh J
        • Oetgen W
        • et al.
        The association between hospital volume and survival after acute myocardial infarction in elderly patients.
        N Engl J Med. 1999; 340: 1640-1648
        • Yuan Z
        • Cooper G
        • Einstadter E
        • et al.
        The association between hospital type and mortality and length of stay.
        Med Care. 2000; 38: 231-245
        • Allison J.J
        • Kiefe C.I
        • Weissman N.W
        • et al.
        Relationship of hospital teaching status with quality of care and mortality for Medicare patients with acute MI.
        JAMA. 2000; 284: 1256-1262
        • Jollis J.G
        • DeLong E.R
        • Peterson E.D
        • et al.
        Outcome of acute myocardial infarction according to the specialty of the admitting physician.
        N Engl J Med. 1996; 335: 1880-1887
        • Allison J.J
        • Kiefe C.I
        • Weissman N.W
        • et al.
        Quality of care at teaching and nonteaching hospitals.
        JAMA. 2000; 284: 1220-1222
        • Rosenthal G
        • Harper D
        • Quinn L
        • et al.
        Severity-adjusted mortality and length of stay in teaching and nonteaching hospitals.
        JAMA. 1997; 278: 485-490
        • Taylor D
        • Whellan D
        • Sloan F
        Effects of admission to a teaching hospital on the cost and quality of care for Medicare beneficiaries.
        N Engl J Med. 1999; 340: 293-299
        • Iezzoni L
        The risks of risk adjustment.
        JAMA. 1997; 278: 1600-1607
        • Iezzoni L
        • Ash A
        • Shwartz M
        • et al.
        Judging hospitals by severity adjusted mortality rates.
        Am J Public Health. 1996; 86: 1379-1387
        • Pine M
        • Jones B
        • Lou Y
        Laboratory values improve predictions of hospital mortality.
        Int J Qual Health Care. 1998; 10: 491-501
        • Pine M
        • Norusis M
        • Jones B
        • et al.
        Predictions of hospital mortality rates.
        Ann Intern Med. 1997; 126: 347-354
        • Iezzoni L
        • Shwartz M
        • Moskowitz M.A
        • et al.
        Illness severity and costs of admission at teaching and nonteaching hospitals.
        JAMA. 1990; 264: 1426-1431
        • Iezzoni L
        Major teaching hospitals defying Darwin.
        JAMA. 1997; 278: 520-521