Association of Academic Medical Center Presence With Clinical Outcomes at Neighboring Community Hospitals Among Medicare Beneficiaries

Abstract

ImportanceStudies suggest that academic medical centers (AMCs) have better outcomes than nonteaching hospitals. However, whether AMCs have spillover benefits for patients treated at neighboring community hospitals is unknown.ObjectiveTo examine whether market-level AMC presence is associated with outcomes for patients treated at nonteaching hospitals within the same markets.Design, Setting, and ParticipantsThis retrospective, population-based cohort study assessed traditional Medicare beneficiaries aged 65 years and older discharged from US acute care hospitals between 2015 and 2017 (100% sample). Data were analyzed from August 2021 to December 2022.ExposuresThe primary exposure was market-level AMC presence. Health care markets (ie, hospital referral regions) were categorized by AMC presence (percentage of hospitalizations at AMCs) as follows: no presence (0%), low presence (>0% to 20%), moderate presence (>20% to 35%), and high presence (>35%).Main Outcomes and MeasuresThe primary outcomes were 30-day and 90-day mortality and healthy days at home (HDAH), a composite outcome reflecting mortality and time spent in facility-based health care settings.ResultsThere were 22 509 824 total hospitalizations, with 18 865 229 (83.8%) at non-AMCs. The median (IQR) age of patients was 78 (71-85) years, and 12 568 230 hospitalizations (55.8%) were among women. Of 306 hospital referral regions, 191 (62.4%) had no AMCs, 61 (19.9%) had 1 AMC, and 55 (17.6%) had 2 or more AMCs. Markets characteristics differed significantly by category of AMC presence, including mean population, median income, proportion of White residents, and physicians per population. Compared with markets with no AMC presence, receiving care at a non-AMC in a market with greater AMC presence was associated with lower 30-day mortality (9.5% vs 10.1%; absolute difference, −0.7%; 95% CI, −1.0% to −0.4%; P < .001) and 90-day mortality (16.1% vs 16.9%; absolute difference, −0.8%; 95% CI, −1.2% to −0.4%; P < .001) and more HDAH at 30 days (16.49 vs 16.12 HDAH; absolute difference, 0.38 HDAH; 95% CI, 0.11 to 0.64 HDAH; P = .005) and 90 days (61.08 vs 59.83 HDAH; absolute difference, 1.25 HDAH; 95% CI, 0.58 to 1.92 HDAH; P < .001), after adjustment. There was no association between market-level AMC presence and mortality for patients treated at AMCs themselves.Conclusions and RelevanceAMCs may have spillover effects on outcomes for patients treated at non-AMCs, suggesting that they have a broader impact than is traditionally recognized. These associations are greatest in markets with the highest AMC presence and persist to 90 days.

Trends in healthy days at home for Medicare beneficiaries using the emergency department

“…All time spent in inpatient, observation, SNF, inpatient psychiatry, inpatient rehabilitation, and longterm hospital settings were defined as the total time spent in each of these respective settings after the index visit. Consistent with other studies using HDAH, 12,17,25 we counted an ED visit as one day, in contrast to other measures that have counted ED visits as half of a day. 26,27 We considered multiple ED visits per person within the same 30-day period as separate index visits and counted these visits toward deductions in HDAH from previous ED visits.…”

Clinical Productivity and Patient Complexity of Academic Rhinologists: An Analysis of Medicare Metrics

“…Despite teaching roles and academic contributions, these physicians often practice primarily in community settings that treat a greater volume of Medicare patients. 21 Physicians at these hospitals are equipped to provide a high volume of routine procedures that reimburse less compared to the rare and complex pathologies that require advanced expertise, multidisciplinary care, and advanced equipment available at tertiary academic medical centers. 13,22,23 In fact, a study on sinusitis referrals revealed that patients who presented to a community setting with more advanced disease and higher burden of comorbidities were likely to get referred to an academic center that treat more complex patient populations.…”

Retainment of U.S. Orthopaedic Surgeons in Academia from 2016 to 2022

“…Academic medical centers serve a vital role in the U.S. health-care system by providing clinical care, conducting research, and encouraging innovation 1 . Prior research has shown a decrease in blunt trauma mortality and intensive care unit stays at academic medical centers compared with community medical centers 2 , with academic medical centers having positive spillover effects on local health-care centers 3 . Academic medical centers rely on academic physicians who provide tutelage to trainees and advance their respective fields through research and collaboration 4 .…”