Case Mix, Costs, and Outcomes: Differences Between Faculty and Community Services in a University Hospital

Abstract

In order to gain insight into the possible consequences of prospective payment for university hcspitals, we studied 2,025 admissions to the faculty and community services of a university hospital, measuring differences in case mix, costs, and outcomes. The faculty service case mix was disproportionately weighted toward the more costly diagnoses, but even after adjustment for diagnosis-related groups (DRGs), costs were 11 percent higher on the faculty service. The differential was proportionately greater for diagnostic costs than for routine or treatment costs, and the differential was particularly large (70 percent) for patients with a predicted probability of death (DTHRISK) of .25 or greater. The in-hospital mortality rate was appreciably lower on the faculty service after adjustment for case mix and patient characteristics. The mortality differential between the two services was particularly large for patients in the high death risk category. Comparison of a matched sample of 51 pairs of admissions from the high death risk category confirmed the above results with respect to costs and in-hospital mortality, but follow-up revealed that the mortality rates were equal for the two services at nine months after discharge.

Teaching status and resource use for patients with acute myocardial infarction: a new look at the indirect costs of graduate medical education.

“…In our single hospital setting the primary difference between the teaching and nonteaching services was the presence of the teaching program and not other institutional or organizational characteristics. Results 2,4,6,7,9 Certain characteristics of the decision-making process on the teaching services may also have influenced the pattern of procedure use we found. Before a patient on the teaching service underwent a procedure, the housestaff, teaching attending, private attending, and the cardiologist came to a working agreement on a treatment plan.…”

Health and Surgical Outcomes in Canada and the United States

“…Intensity of treatment may also bring short-term (but not long-term) survival benefits. 22 Both the cause of the higher acute mortality in Manitoba and the improved subsequent survival of Manitoba hip fracture patients bear further scrutiny. Comparisons between jurisdictions highlight areas where quality might be improved; the Manitoba short-term survival rates should not be seen as written in stone.…”

The Relationship between the Cost and Quality of Hospital Care: A Review of the Literature

“…The work of Garber, Fuchs, and Silverman (1984) also supports the underlying thesis of the Donabedian model, namely, that strategies of care play a key role in determining the cost-quality relationship. Recall that this work evaluated the relationship between cost and outcomes of care for patients in 12 different DRGs who were treated by either faculty or community physicians.…”

“…The complexity of the cost-quality relationship is also demonstrated by the work of Garber, Fuchs, and Silverman (1984), who compared patients admitted to the faculty and community services at Stanford University Hospital. The faculty service was staffed by full-time faculty members at Stanford University, while the community service used other physicians in the community.…”