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---------------------------------------------------------------------------- JAMA Abstracts - August 13, 1997 ---------------------------------------------------------------------------- Severity-Adjusted Mortality and Length of Stay=20 in Teaching and Nonteaching Hospitals ---------------------------------------------------------------------------- Results of a Regional Study Gary E. Rosenthal, MD; Dwain L. Harper, DO; Linda M. Quinn, MS; Gregory S. Cooper, MD Context.=97Major teaching hospitals are perceived as being more expensive than other hospitals and, thus, unattractive to managed care. However, little empirical data exist about their relative quality and efficiency. The current study compared severity-adjusted mortality and length of stay (LOS) in teaching and nonteaching hospitals. Design.=97Retrospective cohort study. Setting.=97Thirty hospitals in northeast Ohio. Patients.=97A total of 89,851 consecutive eligible patients discharged in 1991 through 1993 with myocardial infarction, congestive heart failure, obstructive airway disease, gastrointestinal hemorrhage, pneumonia, or= stroke. Main Outcome Measures.=97In-hospital mortality and LOS of patients in major teaching (n=3D5), minor teaching (n=3D6), and nonteaching (n=3D19) hospitals= were adjusted for admission severity of illness using multivariable models based on demographic and clinical data abstracted from patients' medical records. Results.=97The adjusted odds of death was 19% lower (95% confidence interval [CI], 2%-34%; P=3D.03) for patients in major teaching hospitals compared wit= h nonteaching hospitals but was similar (95% CI, 7% lower to 28% higher; P=3D.28) for patients in minor teaching hospitals. The findings were generally consistent in analyses stratified according to diagnosis, age, race, predicted risk of death, and other covariates. In addition, risk-adjusted LOS was 9% lower (95% CI, 8%-10%; P<.001) among patients in major teaching hospitals relative to nonteaching hospitals but was similar (95% CI, 2% lower to 11% higher; P=3D.17) in minor teaching hospitals. Major teaching hospitals also cared for higher proportions of nonwhite and poorly insured patients. Conclusions.=97Risk-adjusted mortality and LOS were lower for patients in major teaching hospitals than for patients in minor teaching and nonteaching hospitals. If generalizable to other regions, the results provide evidence that hospital performance, as assessed by 2 commonly used indicators, may be higher in major teaching hospitals. These findings are noteworthy at a time when the viability of many major teaching hospitals is threatened by powerful health care market forces and by potential changes in federal financing of graduate medical education. JAMA. 1997;278:485-490 ---------------------------------------------------------------------------- >From the Divisions of General Internal Medicine (Dr Rosenthal and Ms Quinn) and Gastroenterology (Dr Cooper), Department of Medicine, Case Western Reserve University School of Medicine; the Program in Health Care Research, Cleveland Veterans Administration Medical Center (Drs Rosenthal and Cooper and Ms Quinn); and Quality Information Management Corporation (Dr Harper) Cleveland, Ohio. ---------------------------------------------------------------------------- EDITOR'S NOTE.=97Major teaching hospitals provide clinical services, sponsor research, and educate young physicians. Compared with community hospitals, major teaching institutions have been thought to be costly and inefficient. This study examined almost 90,000 patients who were hospitalized in 30 hospitals in the Cleveland metropolitan area. After adjustment for severity of illness, patients admitted to major teaching hospitals had lower mortality and shorter length of stay compared with those admitted to minor teaching and nonteaching hospitals. This study questions the conventional wisdom that major teaching hospitals are less efficient; it also suggests that differences in outcome may result if patients are shifted from teaching hospitals to those that are perceived, rightly or wrongly, to be less costly. David S. Cooper, MD, Contributing Editor ---------------------------------------------------------------------------- Contents copyright 1997 American Medical Association. All rights reserved <http://www.ama-assn.org/sci-pubs/journals/most/recent/issues/jama/joc6f06a. htm> ----------------------------------------------------------------------------