You’re sick or you need surgery. You have to go to the hospital. Which one do you choose?
A new study published in the Journal of the American Medical Association (JAMA) shows major teaching hospitals are, on average, excelling in a key factor—mortality. The study found that unadjusted 30-day mortality rates at major teaching hospitals were lower by 1.5 percentage points than those at nonteaching hospitals—8.1% compared with 9.6%—with the difference in adjusted rates between the two groups equating to saving one life for every 67 Medicare patients admitted.
While past studies comparing outcomes at U.S. hospitals suggest that patients generally fare better at teaching hospitals, no such studies have been conducted in recent years.
“While we know that teaching hospitals fulfill an important mission around teaching and research, we have known less about the quality of care they provide,” said senior author Ashish Jha, MD, MPH, K.T. Li Professor of Health Policy at Harvard T.H. Chan School of Public Health and director of the Harvard Global Health Institute. “We find that across a very wide range of medical and surgical conditions, patients receiving care at teaching hospitals have superior outcomes.”
The researchers examined more than 21 million Medicare hospitalizations at more than 4,000 hospitals, including teaching, major teaching, and nonteaching facilities. They looked at rates for 15 common medical conditions and six surgical procedures. Teaching hospitals had lower mortality rates for 11 conditions, including respiratory disease, renal failure, pneumonia, COPD, and congestive heart failure. Among surgeries, the same pattern held for 30-day unadjusted mortality, with 3% mortality at teaching hospitals, 3.7% at minor teaching hospitals, and 4.3% at nonteaching hospitals.
“We find that across a very wide range of medical and surgical conditions, patients receiving care at teaching hospitals have superior outcomes.”
Ashish Jha, MD, MPH
Harvard T.H. Chan School of Public Health
“All hospitals are vital to providing critical access to all patients, but this study demonstrates what we have known for many years; when it comes to a tangible quality measure that patients care about—mortality—teaching hospitals provide the best possible care,” said Janis Orlowski, MD, AAMC chief health care officer.
In addition, major teaching hospitals had lower unadjusted seven-day and 90-day mortality rates—by 0.3 and 1.6 percentage points, respectively—than nonteaching hospitals.
“This also highlights the complexity of quality measures and contradicts some of the current metrics used to determine the value of care provided at teaching hospitals, illustrating the need to provide consumers and payers a richer portrait of quality measurements,” Orlowski added.
The researchers stated that further investigation is necessary to determine the cause of the differences. However, they speculated that teaching hospitals may be earlier adopters of technologies and treatments that yield better outcomes.
“Academic medical centers provide a unique environment, with 24-hour availability of specialty services, advanced technologies, and some of the most expert physicians in the country,” said lead study author Laura Burke, MD, instructor of health policy and management at the Harvard Chan School and an emergency physician at Beth Israel Deaconess Medical Center. “This seems to pay off for patients. While obviously not all patients can receive care in major teaching hospitals, understanding which strategies and resources are particularly important to patient outcomes, and how they can be replicated among nonteaching hospitals, is critically important to improve care for all patients.”
This work was completed with a grant from the AAMC, NewYork-Presbyterian Hospital, and Cedars-Sinai Medical Center. The AAMC did not have a role in the study, its outcomes, or the peer review process for publication.