Medical Effectiveness/Outcomes Research

Teaching hospitals appear to provide better care for two common conditions than nonteaching hospitals

Teaching hospitals are recognized for treating rare or severe diseases. But how well do they treat common illnesses such as congestive heart failure and pneumonia? Apparently quite well, according to a new study supported by the Agency for Health Care Policy and Research (HS06331). The study showed that teaching hospitals provided better care for patients with these two common illnesses than nonteaching hospitals.

Researchers led by John Z. Ayanian, M.D., of Harvard Medical School and Brigham and Women's Hospital in Boston, selected a random sample of Medicare hospital discharges between September 1991 and August 1992 from four States (Illinois, Massachusetts, New York, and Pennsylvania), including those associated with readmission within 31 days of initial hospitalization, with a principal diagnosis of congestive heart failure or pneumonia. The sample included approximately 900 patients with each principal diagnosis. A nurse abstracter from each State used hospital records of these discharged patients to assess quality of care using four explicit process scales: thoroughness of history taking and physical exams, whether elements of functional status and key symptoms and signs were recorded, use of appropriate tests, and use of standard therapies for both conditions. Two physician reviewers also judged the overall quality of care through structured implicit review of the hospital records.

Physicians were most likely to rate care as good to excellent in major teaching hospitals and less than adequate in nonteaching hospitals for both conditions. Quality of care also was rated better in major and other teaching hospitals than nonteaching hospital by explicit process scales. For instance, physicians at major and other teaching hospitals were more apt than physicians at nonteaching hospitals to perform a lung exam for patients with these conditions on the second hospital day. They also were more apt to measure potassium and creatinine levels on the third hospital day in congestive heart failure patients when clinically indicated. The researchers conclude that, if teaching hospitals can maintain their quality of care while containing their costs, they will remain valued sites of care for patients with common medical problems.

More details are in "Quality of care for two common illnesses in teaching and nonteaching hospitals," by Dr. Ayanian, Joel S. Weissman, Ph.D., Scott Chasan-Taber, Ph.D., and Arnold M. Epstein, M.D., in November 1998 Health Affairs 17(6), pp. 194-205.

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