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 Researchers reviewed millions of records for patients aged 65 and
older and insured by Medicare, the U.S. health program for the
elderly. They found 8.3 percent of patients died within 30 days of
hospitalization at major teaching hospitals, compared with 9.2
percent at minor teaching hospitals and 9.5 percent at community
hospitals.
“We found, to our surprise, that across a wide range of medical and
surgical conditions, patients at teaching hospitals did better -
they were less likely to die,” said senior study author Dr. Ashish
Jha of the Harvard T.H. Chan School of Public Health in Boston.
“While mortality may not be the only indicator that matters, it
certainly is the most important one,” Jha said by email. “We know
that short term mortality is driven largely by how well the hospital
does in taking care of patients.”
Academic medical centers are often considered more expensive than
community hospitals and some insurers have excluded teaching
hospitals from their networks in an attempt to control costs,
assuming that quality is comparable, Jha and colleagues note in JAMA.
For the study, researchers reviewed records from 21.4 million
hospitalizations at 4,483 hospitals nationwide. This included 250
facilities designated as major teaching hospitals with membership in
the Council of Teaching Hospitals, 894 hospitals with medical school
affiliations designated as minor teaching hospitals, and 3,339
community hospitals.
When researchers looked at hospitals by size, they found teaching
hospitals had lower death rates than non-teaching hospitals when the
facilities were large, with at least 400 beds, and medium-sized,
with 100 to 399 beds.
Among small hospitals with 99 or fewer beds, minor teaching
hospitals had lower death rates than community hospitals, the study
also found.
Teaching hospitals still had lower death rates after researchers
accounted for differences in the patients at the various hospital
types, and for other characteristics of the hospitals themselves.
One limitation of the study is that it only included certain
Medicare patients, and the results might not be representative of
what death rates would look like for people at other ages or with
other types of insurance, the authors note.
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The lower death rates for teaching hospitals are surprising for two
reasons, said Dr. Vineet Arora of the University of Chicago: they
have more doctors in training who might make more mistakes than
seasoned physicians and they often treat patients too sick or badly
injured to get care at community hospitals who are more likely to
die.
“The fact that we did not see this is reassuring,” Arora, who wasn’t
involved in the study, said by email.
It’s possible, too, that the added supervision trainees receive
ensures that physicians are available around the clock when
emergencies arise or patients deteriorate, improving mortality rates
by saving patients who might otherwise have died, said Dr. Karl
Bilimoria of Northwestern University Feinberg School of Medicine in
Chicago.
“This study is critically important in that it shows lower mortality
rates at teaching hospitals, thus demonstrating that care is quite
safe at major academic centers even when trainees are involved,”
Bilimoria, who wasn’t involved in the study, said by email.
“Mortality is the bottom line of health care,” Bilimoria added. “It
is critically important and it is also a very fair and well-done
metric, so patients should have more faith in that measure of
hospital quality than many others.”
SOURCE: http://bit.ly/2rN3Srf JAMA, May 23, 2017.
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