JAMA
2000 Sep 13;284(10):1256-62
Comment in:
JAMA. 2000 Dec 20;284(23):2994-5.
Relationship of hospital teaching status with quality of care and mortality
for Medicare patients with acute MI.
Allison JJ, Kiefe CI, Weissman NW, Person SD, Rousculp M, Canto JG, Bae
S, Williams OD, Farmer R, Centor RM.
University of Alabama at Birmingham, 1530 Third Ave S, MEB 621, Birmingham,
AL 35294-3296, USA. jallison@uab.edu
CONTEXT: Issues of cost and quality are gaining importance
in the delivery of medical care, and whether quality of care is better
in teaching vs nonteaching hospitals is an essential question in this
current national debate.
OBJECTIVE: To examine the association of hospital teaching
status with quality of care and mortality for fee-for-service Medicare
patients with acute myocardial infarction (AMI).
DESIGN, SETTING, AND PATIENTS: Analysis of Cooperative
Cardiovascular Project data for 114,411 Medicare patients from 4361 hospitals
(22,354 patients from 439 major teaching hospitals, 22,493 patients from
455 minor teaching hospitals, and 69,564 patients from 3467 nonteaching
hospitals) who had AMI between February 1994 and July 1995.
MAIN OUTCOME MEASURES: Administration of reperfusion
therapy on admission, aspirin during hospitalization, and beta-blockers
and angiotensin-converting enzyme inhibitors at discharge for patients
meeting strict inclusion criteria; mortality at 30, 60, and 90 days and
2 years after admission.
RESULTS: Among major teaching, minor teaching, and nonteaching
hospitals, respectively, administration rates for aspirin were 91.2%,
86.4%, and 81.4% (P<.001); for angiotensin-converting enzyme inhibitors,
63. 7%, 60.0%, and 58.0% (P<.001); for beta-blockers, 48.8%, 40.3%,
and 36.4% (P<.001); and for reperfusion therapy, 55.5%, 58.9%, and
55.2% (P =.29). Differences in unadjusted 30-day, 60-day, 90-day, and
2-year mortality among hospitals were significant at P<.001 for all
time periods, with a gradient of increasing mortality from major teaching
to minor teaching to nonteaching hospitals. Mortality differences were
attenuated
by adjustment for patient characteristics and were almost eliminated by
additional adjustment for receipt of therapy.
CONCLUSIONS: In this study of elderly patients with AMI,
admission to a teaching hospital was associated with better quality of
care based on 3 of 4 quality indicators and lower mortality. JAMA. 2000;284:1256-1262
PMID: 10979112 [PubMed - indexed for MEDLINE]
JAMA 2000 Dec 20;284(23):2994-5
Comment on:
JAMA. 2000 Sep 13;284(10):1256-62.
Quality of care at teaching and nonteaching hospitals.
Thiemann DR, Coresh J, Powe NR.
Publication Types: Comment; Letter
PMID: 11122577 [PubMed - indexed for MEDLINE]
