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December 20, 2000

Quality of Care at Teaching and Nonteaching Hospitals—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(23):2994-2995. doi:10.1001/jama.284.23.2993

In Reply: As stated in our original article, we recognized that selection bias might be an issue, and we analyzed the data with and without transfer patients separately. Our results did not change appreciably: unadjusted 30-day mortality rates for major teaching, minor teaching, and nonteaching hospitals were 17.0%, 18.2%, and 20.1%, respectively (P<.001), with transfer patients included and 18.7%, 20.3%, 23.3%, respectively (P<.001), with transfer patients excluded. We noted the difficulty in attributing transfer patient mortality to a particular hospital when the patients may have received the majority of their care at another hospital, especially when the events are not recorded in the CCP data set, and we described our approach to transfer patients explicitly.

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