Question

Please explain, pursuant to the Report of the Harvard Medical Practice, what role age plays as a factor for adverse events. Is there any correlation between age and the primary type of adverse event (negligence)? Secondly, is there any correlation between the type of hospital involved (i.e. government, non-profit, private propriety) and adverse events involving negligence? What about teaching hospitals vs. non-teaching hospitals?

Answer 1

Compared with nonteaching hospitals, U.S. teaching hospitals deliver higher quality and more-complex care for many conditions, but patient satisfaction is lower.

Teaching hospitals provide care for the most-complex patients and the urban underserved population, train the next generation of physicians, and advance biomedical research. But do they provide better and safer care than nonteaching hospitals?

Researchers compared performance on a variety of publicly reported metrics between U.S. nonteaching hospitals and minor teaching hospitals (self-reported teaching status) or major teaching hospitals (Council of Teaching Hospitals members; i.e., academic medical centers). Performance metrics included structural measures of quality (electronic medical record adoption, trauma center designation, procedural volume, 24-hour intensive care unit staffing), process and outcome measures of quality (30-day disease-specific readmission rates and mortality), indicators of safety (hospital-acquired infections, computerized provider order entry adoption), patient satisfaction (based on Hospital Consumer Assessment of Health Care Providers and Systems reports [HCAHPS]), and cost.

Findings showed that teaching hospitals more often are located in urban areas, represent the majority of level 1 trauma and transplant centers, and have higher case-mix indices. Mortality from acute myocardial infarction (AMI), heart failure, and pneumonia were lower at teaching hospitals, whereas readmission rates for pneumonia and AMI were higher. Teaching hospitals more often were adherent to Leapfrog standards. Costs of care were similar between teaching and nonteaching hospitals after adjustment for geographic cost of living, patient complexity, and indigent populations. However, patient HCAHPS satisfaction scores consistently were lower at teaching hospitals.