THE VOLUME AND MIX OF INPATIENT SERVICES PROVIDED BY ACADEMIC MEDICAL-CENTERS

This is the first in a series of AAMC Papers that analyze the clinical spectrum of patients treated in the nation's reaching hospitals, As s tated in the separate Introduction, ''The Transformation of Data into Knowledge,'' subsequent papers will examine trends in the provision of care to the indigent and make comparisons of quality of care among te aching and nan-teaching hospitals, These analyses, carried Out by the AAMC's Center for the Assessment and Management: of Change in Academic Medicine (CAMCAM), are made possible by a reorganization of the AAMC' s information infrastructure, in which many formerly separate database s have been linked The Introduction concludes with a description of sp ecific AAMC-CAMCAM initiatives that are being planned. This initial an alysis examines the volume and mis of clinical services provided by AM Cs, examines trends In these services over time, and compares services provided at different AMCs, in different markets, and between AMCs an d non-teaching hospitals, Data from a variety of sources were used in these secondary analyses. The American Hospital Association's Annual S urvey of Hospitals database was used to analyze volumes of inpatient s ervices provided in AMCs and other hospitals. The AAMC's Clinical-Admi nistrative Data Service database was used to analyze the volume and mi x of clinical services provided in individual AMCs. The Agency for Hea lth Care Policy and Research's Nationwide Inpatient Sample was used to compare the mix of clinical services provided in AMCs and other hospi tals. Volumes of inpatient services in AMCs changed little between 199 1 and 1994 and totaled six million hospitalizations, 41 million inpati ent days, and two million inpatient surgeries in 1994. The mix of inpa tient services in AMCs also showed little variation over time among in dividual AMCs, in markets with both high and low managed care penetrat ions, between public and private AMCs, or between AMCs and non-reachin g hospitals, with the ten most frequent: diagnoses accounting for sign ificant proportions of total services. In contrast, several specialize d services were much more likely to be offered and provided by AMCs. D espite rapid change in the hearth care environment, the volume and mix of clinical services provided by AMCs have been relatively stable. Im plications for hospital planners, service chiefs and administrators, m edical educators, clinical investigators, and health policymakers are discussed.