Teaching and safety-net hospitals show variations in quality and outcomes of care

June 17, 2013

Teaching hospitals with a higher intensity of physician-training activity achieve lower mortality rates, but higher hospitalization readmission rates for key medical diagnoses, reports a study in the July issue of Medical Care.

The disparity in readmissions is greatest for "safety-net" hospitals serving low-, according to the new research led by Dr Stephanie K. Mueller of Brigham and Women's Hospital, Boston. They write, "These findings suggest that high teaching intensity and safety-net institutions may be disproportionately affected by recent and upcoming changes in hospital payment models."

Variations in Outcomes at Higher-Intensity Teaching Hospitals…

Using two nationally representative databases, the researchers evaluated the relationship between hospital teaching status, the quality of care provided, the patients outcomes achieved. Teaching hospitals—those which train —were classified by teaching intensity, based on the ratio of residents to patient beds.

The study focused on three conditions widely used in assessing the quality and outcomes of hospital care: (heart attack), , and pneumonia. In addition to teaching status, the researchers looked for possible differences in quality of care at safety-net hospitals—those treating a high proportion of .

The study included data on 2,418 hospitals for the years 2007-08. Overall, 37 percent of hospitals were teaching hospitals. Five percent were medium-intensity and three percent were high-intensity teaching hospitals.

The teaching and nonteaching hospitals performed "uniformly well" on quality of care process measures. This meant that they had high rates of performing and reporting recommended care steps for all three diagnoses.

But there were some significant differences in by teaching hospital status. Medium- and high-intensity teaching hospitals had higher rates of repeat hospital admission for patients with all three conditions, compared to nonteaching hospitals.

In contrast, for and heart failure, high-intensity teaching hospitals had lower than nonteaching hospitals. The differences in outcomes remained significant after adjustment for patient risk factors.

Differences Are Most Pronounced at Safety-Net Hospitals

For the two heart disease diagnoses, there was a significant interaction between teaching intensity and safety net status. Among hospitals that served a higher percentage of Medicaid patients, higher-intensity teaching hospitals had persistently higher readmission rates for myocardial infarction and

Traditionally, teaching hospitals have been supported by a combination of patient revenues and government subsidies. Pressures to reduce government support for medical education pose a threat to the financial health of teaching institutions. Many teaching hospitals are also safety-net hospitals, which serve higher-risk patients. As a result they may also take a financial hit from new payment rules penalizing hospitals with higher readmission rates.

The new study suggests that teaching hospitals—especially higher-intensity teaching hospitals that are also safety-net hospitals—have higher readmission rates for key diagnoses. This is despite the fact that they have lower mortality rates for major heart disease diagnoses.

How to explain this seeming contradiction? Lack of patient education at discharge may contribute to higher readmission rates at teaching hospitals. Another possibility is that patients with more complex conditions treated at teaching hospitals are more likely survive—and more likely to return for care requiring rehospitalization.

The study raises important questions about how changes in hospital payment based on quality and outcome measures may affect funding of , Dr Mueller believes. She comments, "Financial incentives may disproportionately impact the financial health of higher teaching intensity hospitals and safety net hospitals, particularly with respect to penalties for higher readmission rates."

Explore further: Despite financial challenges, safety-net hospitals provide high quality care

Related Stories

60 percent of peds hospitals have electronic health records

April 17, 2013

(HealthDay)—Since 2008 there has been an increase in the proportion of children's hospitals adopting electronic health records (EHRs), with EHRs in almost 60 percent of children's hospitals in 2011, according to research ...

Recommended for you

Children born in the summer more likely to be healthy adults

October 12, 2015

Women who were born in the summer are more likely to be healthy adults, suggests new research published in the journal Heliyon. The authors of the study, which involved almost half a million people in the UK, say more sunlight ...

Mobile app records our erratic eating habits

September 24, 2015

Breakfast, lunch, and dinner? For too many of us, the three meals of the day go more like: office meeting pastry, mid-afternoon energy drink, and midnight pizza. In Cell Metabolism on September 24, Salk Institute scientists ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.