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Evidence that teaching hospitals have better survival outcomes

Quality of care for acute MI patients is better in teaching hospitals, perhaps because they practice evidence-based medicine.

By | September 14, 2000

LONDON, 14 September (SPIS MedWire). Whether quality of care is better in teaching versus non-teaching hospitals is controversial but a recent study published in JAMA suggests that patients with acute myocardial infarction treated in teaching hospitals tend to receive a better quality of care and have lower mortality than those who attend non-teaching hospitals.

A multicenter team, led by Jerome Allison from the University of Alabama at Birmingham, collected data on 114,411 elderly patients who were diagnosed with acute MI on admission to hospital. Overall, 439 major teaching hospitals, 455 minor teaching hospitals and 3,467 non-teaching hospitals were included in the analysis. Among the three types of hospital, respectively, administration rates for aspirin were 91.2%, 86.4% and 81.4% (p<0.001); for ACE inhibitors, 63.7%, 60.0% and 58.0% (p<0.001); for beta-blockers, 48.8%, 40.3% and 36.4% (p<0.001); and for reperfusion therapy, 55.5%, 58.9% and 55.2% (p=0.29). Differences in unadjusted 30-day, 60-day, 90-day and two-year mortality among hospitals were significant at p<0.001, with a gradient of increasing mortality from major teaching to minor teaching to non-teaching hospitals. Mortality differences, however, were attenuated by adjustment for patient characteristics and were almost eliminated by additional adjustment for receipt of therapy.

Allison et al. say that the survival gradient suggests a dose–response effect, with care measures "strongly related" to the mortality advantage seen in teaching hospitals. Less important, they say, are patient and hospital characteristics. The team conclude: "There is substantial room for improvement in all hospitals. However, the emerging trend ... of implementing change in an organizational rather than an individual context offers new hope for improvement."

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