Quality of Care in Teaching Hospitals: A Literature Review

Purpose To compare the quality of care in teaching hospitals with that in nonteaching hospitals. Method By performing a literature review via PubMed, the author identified and surveyed 23 studies that compared the quality of care in teaching hospitals with that in nonteaching hospitals. The studies were published from 1989-2004 and in all but one case dealt exclusively with U.S. hospitals. Results The teaching hospitals studied had better-quality measures than did nonteaching hospitals in the predominant number of studies reviewed. Process measures were significantly better in teaching hospitals in seven of the eight studies where such measures were observed, and equal in the other study. Risk-adjusted mortality was lower in teaching hospitals in nine of the 15 studies using that measure, not significantly different in five, and significantly lower in nonteaching hospitals in one study (in pediatric intensive care units, even though the teaching hospitals had a better process of care). In nonmortality outcomes, teaching hospitals were better in one study using that measure; there were no significant differences in five other such studies. Major teaching hospitals had more favorable outcomes end points than did minor teaching hospitals in eight studies in which they were compared. Including only those six studies using clinical data for process analysis or risk adjustment, teaching hospitals had a better process in all six and lower adjusted mortality in five of seven studies where that measure was used. Conclusions Overall, the favorable results in teaching hospitals extended over a range of locations, conditions, and populations, including routine as well as complex conditions. However, the quality measured in these studies was not at target levels across the spectrum of hospitals. There needs to be a continuous and determined effort for improvement in all institutions. It is to be hoped that teaching hospitals will take the lead not only in continuously improving their own quality, but also in developing and evaluating ever improving methods of quality assessment.

[1]  L I Iezzoni,et al.  Using administrative data to screen hospitals for high complication rates. , 1994, Inquiry : a journal of medical care organization, provision and financing.

[2]  E. McGlynn,et al.  Measuring Quality of Care , 1996 .

[3]  W. Cunningham,et al.  The effect of hospital experience on mortality among patients hospitalized with acquired immunodeficiency syndrome in California. , 1999, The American journal of medicine.

[4]  M. Litwin,et al.  Can hospital structural and financial characteristics explain variations in mortality caused by acute myocardial infarction? , 1999, Applied nursing research : ANR.

[5]  E. DeLong,et al.  Discordance of Databases Designed for Claims Payment versus Clinical Information Systems: Implications for Outcomes Research , 1993, Annals of Internal Medicine.

[6]  A. Rimm,et al.  The Relationship of Hospital Characteristics and the Results of Peer Review in Six Large States , 1991, Medical care.

[7]  F A Sloan,et al.  Effects of admission to a teaching hospital on the cost and quality of care for Medicare beneficiaries. , 1999, The New England journal of medicine.

[8]  J. Weissman,et al.  Quality of care for two common illnesses in teaching and nonteaching hospitals. , 1998, Health affairs.

[9]  B. McNeil,et al.  Using admission characteristics to predict short-term mortality from myocardial infarction in elderly patients. Results from the Cooperative Cardiovascular Project. , 1996, JAMA.

[10]  U E Ruttimann,et al.  Impact of quality-of-care factors on pediatric intensive care unit mortality. , 1995, JAMA.

[11]  B. Starfield.  Quality-of-care research: internal elegance and external relevance. , 1998, JAMA.

[12]  G. Cooper,et al.  Severity-adjusted mortality and length of stay in teaching and nonteaching hospitals. Results of a regional study. , 1998, JAMA.

[13]  G. Rosenthal,et al.  Patient and hospital characteristics associated with patient assessments of hospital obstetrical care. , 1998, Medical care.

[14]  J. Weissman,et al.  Teaching hospitals and quality of care: a review of the literature. , 2002, The Milbank quarterly.

[15]  G. Cooper,et al.  Severity-Adjusted Mortality and Length of Stay in Teaching and Nonteaching Hospitals: Results of a Regional Study , 1997 .

[16]  A A Rimm,et al.  Hospital characteristics and mortality rates. , 1989, The New England journal of medicine.

[17]  J. Butler,et al.  Differences Among Hospitals in Delivery of Care for Heart Failure , 2003, Journal for healthcare quality : official publication of the National Association for Healthcare Quality.

[18]  R. Centor,et al.  Relationship of hospital teaching status with quality of care and mortality for Medicare patients with acute MI. , 2000, JAMA.

[19]  D Draper,et al.  Measuring quality of care with explicit process criteria before and after implementation of the DRG-based prospective payment system. , 1990, JAMA.

[20]  E. Draper,et al.  Value and cost of teaching hospitals: A prospective, multicenter, inception cohort study , 1993, Critical care medicine.

[21]  L. McMahon,et al.  The Measurement of Mortality: A Risk-Adjusted Variable Time Window Approach , 1991, Medical care.

[22]  B. McNeil,et al.  Patient satisfaction as an indicator of quality care. , 1988, Inquiry : a journal of medical care organization, provision and financing.

[23]  D. Whellan,et al.  Effects of admission to a teaching hospital on the cost and quality of care for Medicare beneficiaries. , 1999, The New England journal of medicine.

[24]  N M Laird,et al.  Hospital characteristics associated with adverse events and substandard care. , 1991, JAMA.

[25]  T. Brennan,et al.  Hospital ownership and preventable adverse events , 2000, Journal of General Internal Medicine.

[26]  C. Conover,et al.  Hospital credentialing and quality of care. , 2000, Social science & medicine.

[27]  J. Feinglass,et al.  The importance of surgeon volume and training in outcomes for vascular surgical procedures. , 1999, Journal of vascular surgery.

[28]  José Maria Paganni,et al.  Evaluating the quality of medical care. , 1966, The Milbank Memorial Fund quarterly.

[29]  R H Brook,et al.  Quality of health care. Part 2: measuring quality of care. , 1997, The New England journal of medicine.

[30]  M. Fine,et al.  Relationship of provider characteristics to outcomes, process, and costs of care for community-acquired pneumonia. , 1998, Medical care.

[31]  D Draper,et al.  Hospital characteristics and quality of care. , 1992, JAMA.

[32]  M Pine,et al.  Predictions of Hospital Mortality Rates: A Comparison of Data Sources , 1997, Annals of Internal Medicine.

[33]  P. Shekelle,et al.  Defining and measuring quality of care: a perspective from US researchers. , 2000, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[34]  Kathryn M McDonald,et al.  A national profile of patient safety in U.S. hospitals. , 2003, Health affairs.

[35]  E. Philbin,et al.  Hospital outcomes in major teaching, minor teaching, and nonteaching hospitals in New York state. , 2002, The American journal of medicine.

[36]  Jeffrey Geppert,et al.  Indirect vs direct hospital quality indicators for very low-birth-weight infants. , 2004, JAMA.

[37]  R. Brook,et al.  The effect of alternative case-mix adjustments on mortality differences between municipal and voluntary hospitals in New York City. , 1994, Health services research.

[38]  N. Roos,et al.  Use of claims data systems to evaluate health care outcomes. Mortality and reoperation following prostatectomy. , 1987, JAMA.

[39]  A. Rimm,et al.  The Relationship of Hospital Ownership and Teaching Status to 30− and 180‐Day Adjusted Mortality Rates , 1994, Medical care.

[40]  Sankey V. Williams,et al.  Evaluation of the complication rate as a measure of quality of care in coronary artery bypass graft surgery. , 1995, JAMA.

[41]  K. Lohr,et al.  Monitoring quality of care in the Medicare program. Two proposed systems. , 1987, JAMA.

[42]  J D Horbar,et al.  Hospital and patient characteristics associated with variation in 28-day mortality rates for very low birth weight infants. Vermont Oxford Network. , 1997, Pediatrics.