Major teaching hospitals produce lower mortality rates than non-teaching hospitals

Patients at major teaching hospitals experience better 30-day mortality rates for common conditions than those at non-teaching hospitals, according to a new study.

The research, published in JAMA, surveyed Medicare data of 21.4 million hospitalizations of patients aged 65 and older from 4,483 hospitals. Mortality rates at the 250 major teaching hospitals included in the study were over a percentage point better than those at other hospitals. The differences in adjusted mortality rates were higher among large hospitals than smaller ones, but teaching hospitals still maintained a statistically relevant advantage even after stratifying them by size. A similar result held when the researchers looked at seven-day and 90-day mortality rates.

“We found, to our surprise, that across a wide range of medical and surgical conditions, patients at teaching hospitals did better—they were less likely to die,” senior study author Ashish Jha, M.D., of the Harvard T.H. Chan School of Public Health in Boston, told Reuters.

The study complicates recent findings suggesting the irrelevance of cost to overall quality of care, since people generally acknowledge that teaching hospitals tend to be more expensive than non-teaching institutions, Laura Burke, M.D., one of the study’s authors, told STAT.

“When thinking about cost, taking into account outcomes needs to be part of the discussion,” she points out, suggesting that those who dismiss teaching hospitals out of hand due to their higher cost might be throwing the baby out with the bathwater.

However, Burke, an instructor at the Harvard T.H. Chan School of Public Health and an emergency medicine physician at Beth Israel Deaconess Medical Center in Boston, cautioned against reading the study as a call for people to prioritize teaching hospitals above others for all of their care. The study’s reliance on Medicare data raises questions about whether mortality rates for younger patients would mirror those of the older ones in the Medicare system, notes STAT.

The authors admit that the study sheds little light on why mortality rates at teaching hospitals would be better than those at non-teaching institutions. Burke told STAT she hopes her research will help uncover best practices that non-teaching hospitals might be able to use to improve their quality of care. She and her colleagues have reportedly already begun to study possible reasons that explain the disparity in mortality rates.