Article

Relationship of hospital teaching status with quality of care and mortality for Medicare patients with acute MI

University of Alabama at Birmingham, 1530 Third Ave S, MEB 621, Birmingham, AL 35294-3296, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 30.39). 10/2000; 284(10).
Source: OAI

ABSTRACT Context: Issues of cost and quality are gaining importance in the delivery of medical care, and whether quality of care is better in teaching vs nonteaching hospitals is an essential question in this current national debate. Objective: To examine the association of hospital teaching status with quality of care and mortality for fee-for-service Medicare patients with acute myocardial infarction (AMI). Design, Setting, and Patients: Analysis of Cooperative Cardiovascular Project data for 114411 Medicare patients from 4361 hospitals (22354 patients from 439 major teaching hospitals, 22493 patients from 455 minor teaching hospitals, and 69564 patients from 3467 nonteaching hospitals) who had AMI between February 1994 and July 1995. Main Outcome Measures: Administration of reperfusion therapy on admission, aspirin during hospitalization, and β-blockers and angiotensin-converting enzyme inhibitors at discharge for patients meeting strict inclusion criteria; mortality at 30, 60, and 90 days and 2 years after admission. Results: Among major teaching, minor teaching, and nonteaching hospitals, respectively, administration rates for aspirin were 91.2%, 86.4%, and 81.4% (P<.001); for angiotensin-converting enzyme inhibitors, 63.7%, 60.0%, and 58.0% (P<.001); for β-blockers, 48.8%, 40.3%, and 36.4% (P<.001); and for reperfusion therapy, 55.5%, 58.9%, and 55.2% (P=.29). Differences in unadjusted 30-day, 60-day, 90-day, and 2-year mortality among hospitals were significant at P<.O01 for all time periods, with a gradient of increasing mortality from major teaching to minor teaching to nonteaching hospitals. Mortality differences were attenuated by adjustment for patient characteristics and were almost eliminated by additional adjustment for receipt of therapy. Conclusions: In this study of elderly patients with AMI, admission to a teaching hospital was associated with better quality of care based on 3 of 4 quality indicators and lower mortality.

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    • "Several studies find significant returns to measures of hospital treatment intensity. Allison et al. (2000) find that those treated for Acute Myocardial Infarction (AMI) at teaching hospitals had roughly 10% lower mortality than those treated at non-teaching hospitals, and that this effect persisted for two years after the incident. Most recently, Romley et al. (2011) document that those treated in California hospitals with the highest end-of-life spending have much lower inpatient mortality: inpatient mortality in hospitals at the highest quintile of spending is 10-37% lower than at the lowest quintile across a range of conditions. "
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    • "In their study, it is also the case that ''. . . mortality differences were attenuated by adjustment for patient characteristics and were almost eliminated by additional adjustment for receipt of therapy'' (Allison et al. 2000). Nieuwlaat et al. (2006) addressed a different question: what accounts for the differential utilization of a specific intervention (in this case, reperfusion therapy)? "
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