Impact of Hospital Teaching Intensity on Quality of Care and Patient Outcomes
Bibliographic Data
| ID | 9101297 |
|---|---|
| Authors | Stephanie K Mueller, Stephanie Mueller (0000-0001-5576-4356, Brigham and Women's Hospital, corresponding author), Stuart R Lipsitz (0000-0003-2619-1389, Brigham and Women's Hospital), Stuart Lipsitz, LeRoi S Hicks (UMass Memorial Health Care) |
| Year | 2013 |
| Volume | 51 |
| Issue | 7 |
| Pages | 567-574 |
| Publication date | 2013-07-01 |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0b013e3182902151 |
| PMID | 23604017 |
| OpenAlex | W1975000672 |
| Language | EN |
| Citations received | 5 |
| References cited | 13 |
BACKGROUND: Proposed changes to financing of teaching hospitals and new quality-based performance incentives may differentially impact the financial health of teaching and safety-net institutions. Few data have examined the potential impact of these financial changes on teaching institutions. OBJECTIVES: To determine the association of hospital teaching intensity with processes and outcomes of care for the most common inpatient diagnoses in the United States. RESEARCH DESIGN: Cross-sectional analysis of the 2008 Hospital Quality Alliance and 2007 American Hospital Association databases, adjusted for hospital characteristics. SUBJECTS: A total of 2418 hospitals distributed across the country with available data on teaching intensity (resident-to-bed ratio), quality-of-care process measures, and risk-adjusted readmission and mortality rates for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia. MEASURES: Hospital-level quality-of-care process indicators and 30-day risk-adjusted readmission and mortality rates for AMI, CHF, and pneumonia. RESULTS: Multivariable analysis demonstrates that all hospitals perform uniformly well on quality-of-care process measures for AMI, CHF, and pneumonia. However, when compared with nonteaching hospitals, increasing hospital teaching intensity is significantly associated with improved risk-adjusted mortality for AMI and CHF, but higher risk-adjusted readmission rates for all 3 conditions. Among high teaching intensity hospitals, those with larger Medicaid populations (safety-net institutions) had particularly high readmission rates for AMI and CHF. CONCLUSIONS: In this nationally representative evaluation, we found significant variation in performance on risk-adjusted mortality and readmission rates, and differences in readmission rates based on safety-net status. Our findings suggest that high teaching intensity and safety-net institutions may be disproportionately affected by upcoming changes in hospital payment models
Health care · Heart failure · Medicaid · Medical emergency · Mortality rate · Myocardial infarction · Pneumonia · Emergency Medicine · Healthcare Policy and Management · Hospital Admissions and Outcomes · Internal Medicine · Medicine · Primary Care and Health Outcomes
| Citations per year | 0.38 |
|---|---|
| Citation span | 2013 - 2022 (10) |
| Highly cited | No |