Effects of admission to a teaching hospital on the cost and quality of care for Medicare beneficiaries

Background and Methods We studied the effects of admission to a teaching ho spital on the cost and quality of care for patients covered by Medicare (ag e, 65 years old or older). We used data from the National Long Term Care Su rvey and merged them with Medicare claims data. We selected the first hospi talization for hip fracture (802 patients), stroke (793), coronary heart di sease (1007), or congestive heart failure (604) occurring between January 1 , 1984, and December 31, 1994, and calculated all Medicare payments for inp atient and outpatient care during the six-month period after admission. Sur vival was assessed through 1995. Hospitals were classified as major or mino r teaching hospitals (with minor hospitals defined as those in which the nu mber of residents per bed was less than the median number for all teaching hospitals) or as private nonprofit, government (i.e., public), or private f or-profit hospitals. Results Medicare payments for the six-month period after hospitalization we re highest for patients initially admitted to teaching hospitals for the tr eatment of hip fracture, stroke, or coronary heart disease and for patients initially admitted to for-profit hospitals for the treatment of congestive heart failure. As compared with payments to for-profit hospitals, payments to major teaching hospitals for hip fracture were significantly higher, pa yments to government hospitals for coronary heart disease were lower, and p ayments to government and nonprofit hospitals for congestive heart failure were lower. After adjustment for patients' characteristics and social subsi dies, major teaching hospitals had the lowest mortality rates (hazard ratio for death, 0.75, as compared with for-profit hospitals; 95 percent confide nce interval, 0.62 to 0.91). For individual conditions, the only significan t survival advantage associated with admission to major teaching hospitals was for hip fractures (hazard ratio, 0.54, as compared with for profit hosp itals; 95 percent confidence interval, 0.37 to 0.79), Conclusions Although admission to a major teaching hospital may be associat ed with increased costs to the Medicare program, overall survival for patie nts with the common conditions we studied was better at these hospitals, es pecially for patients with hip fractures. (N Engl J Med 1999;340:293-9.) (C ) 1999, Massachusetts Medical Society.