The purpose of this study was to compare treatment at teaching hospitals with that at non-teaching hospitals with regard to quality of care and mortality for Medicare patients with acute myocardial infarction (AMI).

Data for this study were drawn from the Cooperative Cardiovascular Project (CCP), a medical record review of a large randomly selected sample of Medicare patients with AMI. This study included data for fee-for-service patients with AMI from all 50 states for the period from February 1994 through July 1995. Patients were included if their first index hospitalization was for AMI, they were older than 65 years, they were either African American or white, their hospital teaching status was known, and there was no immediate transfer noted for them. The study sample included 114,411 patients and 4,361 hospitals. It is noteworthy that there were substantial race differences in the distribution of patients based on hospital teaching status (African Americans represented 11.7% of patients in major teaching hospitals, 6.6% in minor teaching hospitals, and 5.3% in non-teaching hospitals).

The proportions of patients receiving aspirin, ACE inhibitors, beta-blockers, and reperfusion therapy who were ideal candidates for each type of therapy were compared by type of hospital (major teaching, minor teaching, and non-teaching). Major teaching hospitals had the highest proportion of ideal candidates receiving aspirin, ACE inhibitors, and beta-blockers. There were no significant differences among the hospital types for reperfusion therapy. Mortality at 30 days, 60 days, 90 days and 2 years was also related to hospital type, with the highest mortality reported at non-teaching hospitals, followed by minor teaching and then major teaching hospitals.

With regard to race, African Americans were less likely to die at 30 days than whites after adjusting for demographic and clinical characteristics (OR=0.79, 95% CI=0.74-0.85), after adjusting for teaching status (OR=0.81, 95% CI=0.76-0.87), and after adjusting for type of therapy received (OR=0.79, 95% CI=0.73-0.85). The authors do not discuss their findings with regard to race.

It is noteworthy that socioeconomic status was not included in the multivariate analyses, nor were insurance status, differences in hospital types other than teaching status, or factors that might influence death after hospital discharge. It is also possible that there were racial differences in the ability to categorize patients into “ideal” treatment categories that should be explored.