The association between hospital type and mortality and length of stay - Astudy of 16.9 million hospitalized Medicare beneficiaries

OBJECTIVES. TO examine the association between hospital type and mortality and length of stay using hospitalized Medicare beneficiaries for a 10-year period. METHODS. The retrospective cohort study included 16.9 million hospitalized Medicare beneficiaries less than or equal to 65 years of age admitted for 1 0 common medical conditions and 10 common surgical procedures from 1984 to 1993. A total of 5,127 acute-care hospitals in the United States were group ed into 6 mutually exclusive hospital types based on teaching status and fi nancial structure (for-profit [FP], not-for-profit [NFP], osteopathic [OSTE O], public [PUB], teaching not-for-profit [TNFP], and teaching public [TPUB ]) as reported in the 1988 American Hospital Association database. Logistic and linear regression methods were used to examine risk-adjusted 30-day an d 6-month mortality and length of stay. RESULTS. During the 10-year study period, 10.6 million patients were admitt ed with 1 of the 10 selected medical conditions, and 6.3 million patients w ere hospitalized for 1 of the 10 selected surgical procedures. Patients at TNFP hospitals had significantly lower risk-adjusted 30-day mortality rates than patients at other hospital types when all diagnoses or procedures wer e combined (combined diagnoses: RRTNFP = 1.00 [reference], RRTPUB = 1.40, R ROSTEO = 1.14, RRPUB = 1.07, RRFP = 1.03, RRNFP = 1.02; combined procedures : RRTNFP = 1.00 [reference], RROSTEO = 1.36, RRTPUB = 1.30, RRPUB = 1.16, R RFP = 1.13, RRNFP = 1.08). The results were mostly consistent when diagnose s and procedures were examined separately. After adjustment for patient cha racteristics, patients at other hospital types had 10% to 20% shorter lengt hs of stay (LOS) than patients at TNFP hospitals for most diagnoses and pro cedures studied. CONCLUSION. AS measured by the risk-adjusted 30-day mortality, TNFP hospita ls had an overall better performance than other hospital types. However, pa tients at TNFP hospitals had relatively longer LOS than patients at other h ospital types, perhaps reflecting the medical education and research activi ties found at teaching institutions. Future research should examine the emp irical evidence to help elucidate the adequate LOS for a given condition or procedure while maintaining the quality of care.