Comparing Outcomes and Costs of Medical Patients Treated at Major Teaching and Non-teaching Hospitals: A National Matche
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Center for Outcomes Research, , Children’s Hospital of Philadelphia, Philadelphia, PA, USA; 2TheDepartment of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; 3Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; 4Department of Health Care Management, Wharton School, University of Pennsylvania, Philadelphia, PA, USA; 5Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; 6Department of Statistics, Wharton School, University of Pennsylvania, Philadelphia, PA, USA; 7Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA; 8Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania, Philadelphia, PA, USA.
BACKGROUND: Teaching hospitals typically pioneer investment in new technology and cultivate workforce characteristics generally associated with better quality, but the value of this extra investment is unclear. OBJECTIVE: Compare outcomes and costs between major teaching and non-teaching hospitals by closely matching on patient characteristics. DESIGN: Medicare patients at 339 major teaching hospitals (resident-to-bed (RTB) ratios ≥ 0.25); matched patient controls from 2439 non-teaching hospitals (RTB ratios < 0.05). PARTICIPANTS: Forty-three thousand nine hundred ninety pairs of patients (one from a major teaching hospital and one from a non-teaching hospital) admitted for acute myocardial infarction (AMI), 84,985 pairs admitted for heart failure (HF), and 74,947 pairs admitted for pneumonia (PNA). EXPOSURE: Treatment at major teaching hospitals versus non-teaching hospitals. MAIN MEASURES: Thirty-day all-cause mortality, readmissions, ICU utilization, costs, payments, and value expressed as extra cost for a 1% improvement in survival. KEY RESULTS: Thirty-day mortality was lower in teaching than non-teaching hospitals (10.7% versus 12.0%, difference = − 1.3%, P < 0.0001). The paired cost difference (teaching − non-teaching) was $273 (P < 0.0001), yielding $211 per 1% mortality improvement. For the quintile of pairs with highest risk on admission, mortality differences were larger (24.6% versus 27.6%, difference = − 3.0%, P < 0.0001), and paired cost difference = $1289 (P < 0.0001), yielding $427 per 1% mortality improvement at 30 days. Readmissions and ICU utilization were lower in teaching
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-019-05449-x) contains supplementary material, which is available to authorized users. Received April 9, 2019 Revised September 15, 2019 Accepted September 26, 2019
hospitals (both P < 0.0001), but length of stay was longer (5.5 versus 5.1 days, P < 0.0001). Finally, individual results for AMI, HF, and PNA showed similar findings as in the combined results. CONCLUSIONS AND RELEVANCE: Among Medicare patients admitted for common medical conditions, as admission risk of mortality incre
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