Relationship of hospital teaching status with quality of care and mortality for Medicare patients with acute MI

Context Issues of cost and quality are gaining importance in the delivery o f medical care, and whether quality of care is better in teaching vs nontea ching hospitals is an essential question in this current national debate. Objective To examine the association of hospital teaching status with quali ty of care and mortality for fee-for-service Medicare patients with acute m yocardial infarction (AMI). Design, setting, and Patients Analysis of Cooperative Cardiovascular Projec t data for 114411 Medicare patients from 4361 hospitals (22 354 patients fr om 439 major teaching hospitals, 22 493 patients from 455 minor teaching ho spitals, and 69 564 patients from 3467 nonteaching hospitals) who had AMI b etween February 1994 and July 1995. Main Outcome Measures Administration of reperfusion therapy on admission, a spirin during hospitalization, and beta-blockers and angiotensin-converting enzyme inhibitors at discharge for patients meeting strict inclusion crite ria; mortality at 30, 60, and 90 days and 2 years after admission. Results Among major teaching, minor teaching, and nonteaching hospitals, re spectively, administration rates for aspirin were 91.2%, 86.4%, and 81.4% ( P<.001); for angiotensin-converting enzyme inhibitors, 63.7%, 60.0%, and 58 .0% (P<.001); for P-blockers, 48.8%, 40.3%, and 36.4% (P<.001); and for rep erfusion therapy, 55.5%, 58.9%, and 55.2% (P = .29). Differences in unadjus ted 30-day, 60-day, 90-day, and 2-year mortality among hospitals were signi ficant at P<.001 for all time periods, with a gradient of increasing mortal ity from major teaching to minor teaching to nonteaching hospitals. Mortali ty differences were attenuated by adjustment for patient characteristics an d were almost eliminated by additional adjustment for receipt of therapy. Conclusions In this study of elderly patients with AMI, admission to a teac hing hospital was associated with better quality of care based on 3 of 4 qu ality indicators and lower mortality.