Mortality Rates Lower at Major Teaching Hospitals

Admission to an academic medical center (AMC) is associated with a lower overall 30-day risk of death compared with admission to a non-teaching hospital, according to a new study.

Researchers at Harvard School of Public Health (HSPH; Boston, MA, USA), Massachusetts General Hospital (MGH; Boston, USA), and other institutions conducted a study using U.S. national Medicare data to compare mortality rates in teaching and non-teaching hospitals for common medical and surgical conditions among beneficiaries 65 years and older. The sample consisted of 21,451,824 total hospitalizations at 4,483 hospitals, of which 250 (5.6%) were major teaching, 894 (19.9%) were minor teaching, and 3,339 (74.3%) were non-teaching hospitals.

The main outcomes and measures were 30-day mortality rate for all hospitalizations and for 15 common medical and 6 surgical conditions. Secondary outcomes included 30-day mortality stratified by hospital size, and 7-day mortality and 90-day mortality for all hospitalizations, as well as for individual medical and surgical conditions. The results revealed that unadjusted 30-day mortality was 8.1% at major teaching hospitals, 9.2% at minor teaching hospitals, and 9.6% at non-teaching hospitals, representing a 1.5% mortality difference between major teaching hospitals and non-teaching hospitals.

After adjusting for patient and hospital characteristics, the same pattern persisted, but the difference in mortality between major and non-teaching hospitals was smaller. Further stratification by hospital size showed that 187 large (over 400 beds) AMCs had lower adjusted overall 30-day mortality (8.1%) relative to 76 large non-teaching hospitals (9.4%). The same pattern was observed in medium-sized hospitals. Among smaller hospitals, with less than 100 beds hospitals, minor teaching hospitals had lower overall 30-day mortality relative to non-teaching hospitals. The study was published on May 23, 2017, in JAMA.

“Academic medical centers provide a unique environment, with 24-hour availability of specialty services, advanced technologies, and some of the most expert physicians in the country. This seems to pay off for patients,” said lead author Laura Burke, MD, of HSPS. “While obviously not all patients can receive care in major teaching hospitals, understanding which strategies and resources are particularly important to patient outcomes, and how they can be replicated among nonteaching hospitals, is critically important to improve care for all patients.”

“We found to our surprise that across a wide range of medical and surgical conditions, patients at teaching hospitals did better; they were less likely to die,” added senior author Ashish Jha, MD, MPH, of HSPS. “While mortality may not be the only indicator that matters, it certainly is the most important one. We know that short term mortality is driven largely by how well the hospital does in taking care of patients.”

AMCs are often considered more expensive than community hospitals and some insurers have excluded them from their networks in an attempt to control costs, assuming that quality is comparable.

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Harvard School of Public Health
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