CARE OF PATIENTS WITH UPPER GASTROINTESTINAL HEMORRHAGE IN ACADEMIC MEDICAL-CENTERS - A COMMUNITY-BASED COMPARISON

Background & Aims: A common perception among purchasers is that academ ic medical centers are inefficient and overutilize technology; however , little empirical information exists. The aim of this study was to co mpare treatment and outcomes of patients with up per gastrointestinal hemorrhage admitted to major teaching hospitals and other hospitals in a large metropolitan area. Methods: Data on 3801 consecutive eligible patients admitted to five major teaching hospitals and 25 other hospi tals from 1991 to 1993 were obtained by review of medical records. Adm ission severity of illness was measured using validated multivariable models. Results: Rates of upper endoscopy were somewhat lower among th e 1004 patients discharged from fellowship hospitals, compared with th e other 2797 patients (82.9% vs. 85.6%; P < 0.05), and the use of othe r procedures was similar. Although patients admitted to fellowship hos pitals tended to have a higher severity of illness, both unadjusted (6 .3 +/- 9.0 vs. 7.1 +/- 7.5 days; P < 0.01) and risk-adjusted length of stay were somewhat shorter. Mortality rates were similar between hosp itals, and patients admitted to fellowship hospitals were somewhat les s likely to be transfused. Conclusions: In patients with upper gastroi ntestinal ;hemorrhage, teaching hospitals do not appear to provide ine fficient care or overutilize expensive treatments when compared with c ommunity facilities. These findings are noteworthy at a time when viab ility of academic centers and fellowship training is threatened.