Clinical study
Hospital outcomes in major teaching, minor teaching, and nonteaching hospitals in New York state

https://doi.org/10.1016/S0002-9343(01)01112-3Get rights and content

Abstract

Purpose

The possible benefit that hospital teaching status may confer in the care of patients with cardiovascular disease is unknown. Our purpose was to determine the effect of hospital teaching status on in-hospital mortality, use of invasive procedures, length of stay, and charges in patients with myocardial infarction, heart failure, or stroke.

Subjects and methods

We analyzed a New York State hospital administrative database containing information on 388 964 consecutive patients who had been admitted with heart failure (n = 173 799), myocardial infarction (n = 121 209), or stroke (n = 93 956) from 1993 to 1995. We classified the 248 participating acute care hospitals by teaching status (major, minor, nonteaching). The primary outcomes were standardized in-hospital mortality ratios, defined as the ratio of observed to predicted mortality.

Results

Standardized in-hospital mortality ratios were significantly lower in major teaching hospitals (0.976 for heart failure, 0.945 for myocardial infarction, 0.958 for stroke) than in nonteaching hospitals (1.01 for heart failure, 1.01 for myocardial infarction, 0.995 for stroke). Standardized in-hospital mortality ratios were significantly higher for patients with stroke (1.06) but not heart failure (1.0) or myocardial infarction (1.06) in minor teaching hospitals than in nonteaching hospitals. Compared with nonteaching hospitals, use of invasive cardiac procedures and adjusted hospital charges were significantly greater in major and minor teaching hospitals for all three conditions. The adjusted length of stay was also shorter for myocardial infarction in major teaching hospitals and longer for stroke in minor teaching hospitals.

Conclusion

Major teaching hospital status was an important determinant of outcomes in patients hospitalized with myocardial infarction, heart failure, or stroke in New York State.

Section snippets

Hospitals

We obtained information on all patients discharged from 261 hospitals in the state of New York from January 1993 to December 1995 from the Statewide Planning and Research Cooperative System (SPARCS) database. SPARCS is an agency of the New York Department of Health that incorporates data on patients hospitalized in acute care facilities from, among other sources, the uniform bill and uniform discharge abstract submitted by hospitals. Hospital characteristics were merged with the original SPARCS

Results

There were 53 (21%) major teaching, 75 (30%) minor teaching, and 120 (49%) nonteaching hospitals (Table 1). Less than half of the patients were admitted to hospitals providing invasive cardiac procedures. Patients with myocardial infarction were younger and more likely to have been male (Table 1). Heart failure patients had more associated comorbid conditions and a higher mean Charlson Index.

Patients with myocardial infarction were more often transferred from one hospital to another (Table 1).

Discussion

We found that adjusted mortality rates for all three diseases were lower in major teaching hospitals compared with minor teaching or nonteaching hospitals, suggesting a beneficial effect of care at these hospitals. Since adjusted mortality rates were similar, if not higher, in minor teaching than in nonteaching hospitals, the beneficial effect of teaching status—at least as defined in this study—extends only to major teaching hospitals in New York State.

Hospital characteristics have important

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