Hospital outcomes in major teaching, minor teaching, and nonteaching hospitals in New York state.
OBJECTIVE
The possible benefit that hospital teaching status may confer in the care of patients with cardiovascular disease is unknown. Our purpose was to determine the effect of hospital teaching status on in-hospital mortality, use of invasive procedures, length of stay, and charges in patients with myocardial infarction, heart failure, or stroke.


METHODS
We analyzed a New York State hospital administrative database containing information on 388 964 consecutive patients who had been admitted with heart failure (n = 173 799), myocardial infarction (n = 121 209), or stroke (n = 93 956) from 1993 to 1995. We classified the 248 participating acute care hospitals by teaching status (major, minor, nonteaching). The primary outcomes were standardized in-hospital mortality ratios, defined as the ratio of observed to predicted mortality.


RESULTS
Standardized in-hospital mortality ratios were significantly lower in major teaching hospitals (0.976 for heart failure, 0.945 for myocardial infarction, 0.958 for stroke) than in nonteaching hospitals (1.01 for heart failure, 1.01 for myocardial infarction, 0.995 for stroke). Standardized in-hospital mortality ratios were significantly higher for patients with stroke (1.06) but not heart failure (1.0) or myocardial infarction (1.06) in minor teaching hospitals than in nonteaching hospitals. Compared with nonteaching hospitals, use of invasive cardiac procedures and adjusted hospital charges were significantly greater in major and minor teaching hospitals for all three conditions. The adjusted length of stay was also shorter for myocardial infarction in major teaching hospitals and longer for stroke in minor teaching hospitals.


CONCLUSIONS
Major teaching hospital status was an important determinant of outcomes in patients hospitalized with myocardial infarction, heart failure, or stroke in New York State.
Polanczyk
Carsi A
CA
Heart Failure and Cardiac Transplantation Unit, Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
Lane
Anthereca
A
Coburn
Michelle
M
Philbin
Edward F
EF
Dec
G William
GW
DiSalvo
Thomas G
TG
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000628:therapy*; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D017722:Hospital Charges; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000145:classification / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D009518:New York; D010043:Outcome and Process Assessment, Health Care; D019984:Quality Indicators, Health Care; D020521:Stroke / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D015031:Zimeldine
D015031:Zimeldine