SEVERITY-ADJUSTED MORTALITY AND LENGTH OF STAY IN TEACHING AND NONTEACHING HOSPITALS - RESULTS OF A REGIONAL STUDY

Context.-Major teaching hospitals are perceived as being more expensiv e than other hospitals and, thug, unattractive to managed care. Howeve r, little empirical data exist about their relative quality and effici ency. The current study compared severity-adjusted mortality and lengt h of stay (LOS) in teaching and nonteaching hospitals. Design.-Retrosp ective cohort study. Setting.-Thirty hospitals in northeast Ohio. Pati ents.-A total of 89 851 consecutive eligible patients discharged in 19 91 through 1993 with myocardial infarction, congestive heart failure, obstructive airway disease, gastrointestinal hemorrhage, pneumonia, or stroke. Main Outcome Measures.-In-hospital mortality and LOS of patie nts in major teaching (n=5), minor teaching (n=6), and nonteaching (n= 19) hospitals were adjusted for admission severity of illness using mu ltivariable models based on demographic and clinical data abstracted f rom patients' medical records. Results.-The adjusted odds of death was 19% lower (95% confidence interval [CI]I 2%-34%; P=.03) for patients in major teaching hospitals compared with nonteaching hospitals but wa s similar (95% CI, 7% lower to 28% higher; P=.28) for patients in mino r teaching hospitals. The findings were generally consistent in analys es stratified according to diagnosis, age, race, predicted risk of dea th, and other covariates. In addition, risk-adjusted LOS was 9% lower (95% CI, 8%-10%; P<.001) among patients in major teaching hospitals re lative to nonteaching hospitals but was similar (95% CI, 2% lower to 1 1% higher; P=.17) in minor teaching hospitals. Major teaching hospital s also cared for higher proportions of nonwhite and poorly insured pat ients. Conclusions.-Risk-adjusted mortality and LOS were lower for pat ients in major teaching hospitals than for patients in minor teaching and nonteaching hospitals. If generalizable to other regions, the resu lts provide evidence that hospital performance, as assessed by 2 commo nly used indicators, may be higher in major teaching hospitals. These findings are noteworthy at a time when the viability of many major tea ching hospitals is threatened by powerful health care market forces an d by potential changes in federal financing of graduate medical educat ion.