| Title |
Comparing Outcomes and Costs of Medical Patients Treated at Major Teaching and Non-teaching Hospitals: A National Matched Analysis
|
|---|---|
| Published in |
Journal of General Internal Medicine, November 2019
|
| DOI | 10.1007/s11606-019-05449-x |
| Pubmed ID | |
| Authors |
Jeffrey H. Silber, Paul R. Rosenbaum, Bijan A. Niknam, Richard N. Ross, Joseph G. Reiter, Alexander S. Hill, Lauren L. Hochman, Sydney E. Brown, Alexander F. Arriaga, Lee A. Fleisher |
| Abstract |
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. Compare outcomes and costs between major teaching and non-teaching hospitals by closely matching on patient characteristics. 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). 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). Treatment at major teaching hospitals versus non-teaching hospitals. Thirty-day all-cause mortality, readmissions, ICU utilization, costs, payments, and value expressed as extra cost for a 1% improvement in survival. 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 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. Among Medicare patients admitted for common medical conditions, as admission risk of mortality increased, the absolute mortality benefit of treatment at teaching hospitals also increased, though accompanied by marginally higher cost. Major teaching hospitals appear to return good value for the extra resources used. |
X Demographics
The data shown below were collected from the profiles of 10 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 6 | 60% |
| Unknown | 4 | 40% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 5 | 50% |
| Practitioners (doctors, other healthcare professionals) | 2 | 20% |
| Scientists | 2 | 20% |
| Science communicators (journalists, bloggers, editors) | 1 | 10% |
Mendeley readers
The data shown below were compiled from readership statistics for 37 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 37 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 6 | 16% |
| Student > Bachelor | 4 | 11% |
| Student > Doctoral Student | 2 | 5% |
| Other | 2 | 5% |
| Professor > Associate Professor | 2 | 5% |
| Other | 5 | 14% |
| Unknown | 16 | 43% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 13 | 35% |
| Nursing and Health Professions | 2 | 5% |
| Biochemistry, Genetics and Molecular Biology | 1 | 3% |
| Mathematics | 1 | 3% |
| Agricultural and Biological Sciences | 1 | 3% |
| Other | 3 | 8% |
| Unknown | 16 | 43% |
Attention Score in Context
This research output has an Altmetric Attention Score of 14. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 24 March 2020.
All research outputs
#2,531,290
of 24,933,778 outputs
Outputs from Journal of General Internal Medicine
#1,860
of 8,063 outputs
Outputs of similar age
#51,882
of 367,015 outputs
Outputs of similar age from Journal of General Internal Medicine
#59
of 217 outputs
Altmetric has tracked 24,933,778 research outputs across all sources so far. Compared to these this one has done well and is in the 89th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 8,063 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 22.1. This one has done well, scoring higher than 76% of its peers.
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We're also able to compare this research output to 217 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 73% of its contemporaries.