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August 13, 1997

Severity-Adjusted Mortality and Length of Stay in Teaching and Nonteaching HospitalsResults of a Regional Study

Author Affiliations

From the Divisions of General Internal Medicine (Dr Rosenthal and Ms Quinn) and Gastroenterology (Dr Cooper), Department of Medicine. Case Western Reserve University School of Medicine; the Program in Health Care Research, Cleveland Veterans Administration Medical Center (Drs Rosenthal and Cooper and Ms Quinn); and Quality Information Management Corporation (Dr Harper) Cleveland, Ohio.

JAMA. 1997;278(6):485-490. doi:10.1001/jama.1997.03550060061037

Context.  —Major teaching hospitals are perceived as being more expensive than other hospitals and, thus, unattractive to managed care. However, little empirical data exist about their relative quality and efficiency. The current study compared severity-adjusted mortality and length of stay (LOS) in teaching and nonteaching hospitals.

Design.  —Retrospective cohort study.

Setting.  —Thirty hospitals in northeast Ohio.

Patients.  —A total of 89 851 consecutive eligible patients discharged in 1991 through 1993 with myocardial infarction, congestive heart failure, obstructive airway disease, gastrointestinal hemorrhage, pneumonia, or stroke.

Main Outcome Measures.  —In-hospital mortality and LOS of patients in major teaching (n=5), minor teaching (n=6), and nonteaching (n=19) hospitals were adjusted for admission severity of illness using multivariable models based on demographic and clinical data abstracted from patients' medical records.

Results.  —The adjusted odds of death was 19% lower (95% confidence interval [CI], 2%-34%; P=.03) for patients in major teaching hospitals compared with nonteaching hospitals but was similar (95% CI, 7% lower to 28% higher; P=.28 for patients in minor teaching hospitals. The findings were generally consistent in analyses stratified according to diagnosis, age, race, predicted risk of death, and other covariates. In addition, risk-adjusted LOS was 9% lower (95% CI, 8%-10%; P<.001) among patients in major teaching hospitals relative to nonteaching hospitals but was similar (95% CI, 2% lower to 11% higher; P=.17) in minor teaching hospitals. Major teaching hospitals also cared for higher proportions of nonwhite and poorly insured patients.

Conclusions.  —Risk-adjusted mortality and LOS were lower for patients in major teaching hospitals than for patients in minor teaching and nonteaching hospitals. If generalizable to other regions, the results provide evidence that hospital performance, as assessed by 2 commonly used indicators, may be higher in major teaching hospitals. These findings are noteworthy at a time when the viability of many major teaching hospitals is threatened by powerful health care market forces and by potential changes in federal financing of graduate medical education.