Comparing Teaching Versus Nonteaching Hospitals

Shahian, David M.; Liu, Xiu; Meyer, Gregg S.; Normand, Sharon‐Lise T.

doi:10.1097/acm.0000000000000050

Cited by 35 publications

(16 citation statements)

References 40 publications

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“…The primary determinant, hospital teaching status, was defined using 3 categories previously described in the literature. 7 , 9 , 13 , 14 , 15 Major teaching hospitals were those that reported membership in the Council of Teaching Hospitals (COTH). Minor teaching hospitals did not have COTH affiliation but reported a medical school affiliation to the American Medical Association.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Costs of Care for Medicare Patients Hospitalized in Teaching and Nonteaching Hospitals

et al. 2019

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Section: Methodsmentioning

confidence: 99%

Comparison of Costs of Care for Medicare Patients Hospitalized in Teaching and Nonteaching Hospitals

et al. 2019

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“…In this study, we did adjust for race and dual eligibility status, which are not included in the quality measurement, but could in part represent unmeasured clinical and social risk factors that may be distributed differently across hospitals. 25–27 These differences could also be due to different care by trainees, who may not yet have an appreciation of the importance of transitions in care; 28,29 and/or competing mortality risk, since teaching hospitals tend to be larger, and high volume centers generally have lower mean 30-day mortality. 30,31 Previous studies, however, have not found strong associations between mortality and readmission rates.…”

Section: Discussionmentioning

confidence: 99%

Hospital Characteristics Associated With Risk-standardized Readmission Rates

et al. 2017

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Background Safety net and teaching hospitals are somewhat more likely to be penalized for excess readmissions, but the association of other hospital characteristics with readmission rates is uncertain and may have relevance for hospital-centered interventions. Objective To examine the independent association of 8 hospital characteristics with hospital-wide 30-day risk-standardized readmission rate (RSRR). Design Retrospective cross-sectional multivariable analysis Subjects US hospitals Measures Center for Medicare and Medicaid Services specification of hospital-wide RSRR from July 1, 2013 through June 30, 2014 with race and Medicaid dual-eligibility added. Results We included 6,789,839 admissions to 4,474 hospitals of Medicare fee-for-service beneficiaries aged over 64 years. In multivariable analyses, there was regional variation: hospitals in the Mid-Atlantic region had the highest RSRRs (0.98 percentage points higher than hospitals in the Mountain region, 95% CI 0.84–1.12). For-profit hospitals had an average RSRR 0.38 percentage points (95% CI, 0.24–0.53) higher than public hospitals. Both urban and rural hospitals had higher RSRRs than those in medium metropolitan areas. Hospitals without advanced cardiac surgery capability had an average RSRR 0.27 percentage points (95% CI, 0.18, 0.36) higher than those with. The ratio of registered nurses per hospital bed was not associated with RSRR. Variability in RSRRs among hospitals of similar type was much larger than aggregate differences between types of hospitals. Conclusions Overall, larger, urban, academic facilities had modestly higher risk-standardized readmission rates than smaller, suburban, community hospitals, although there was a wide range of performance. The strong regional effect suggests that local practice patterns are an important influence. Disproportionately high readmission rates at for-profit hospitals may highlight the role of financial incentives favoring utilization.

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“…For instance, perceptions that AMCs deliver higher-quality care and better outcomes in comparison to non-teaching hospitals can also act as a mechanism that motivates referring physicians and patients' referral preferences. [61][62][63][64][65] In particular, patients and referring physicians' preferences for healthcare facilities can be influenced by the AMCs and specialist…”

Section: Discussionmentioning

confidence: 99%

Determinants of physician networks: an ethnographic study examining the processes that inform patterns of collaboration and referral decision-making among physicians

Kierkegaard

Owen‐Smith

2021

BMJ Open

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ObjectiveMost scholarly attention to studying collaborative ties in physician networks has been devoted to quantitatively analysing large, complex datasets. While valuable, such studies can reduce the dynamic and contextual complexities of physician collaborations to numerical values. Qualitative research strategies can contribute to our understanding by addressing the gaps left by more quantitative approaches. This study seeks to contribute to the literature that applies network science approaches to the context of healthcare delivery. We use qualitative, observational and interview, methods to pursue an in-depth, micro-level approach to the deeply social and discursive processes that influence patterns of collaboration and referral decision-making in physician networks.DesignQualitative methodologies that paired ethnographic field observations, semistructured interviews and document analysis were used. An inductive thematic analysis approach was used to analyse, identify and describe patterns in those data.SettingThis study took place in a high-volume cardiovascular department at a major academic medical centre (AMC) located in the Midwest region of the USA.ParticipantsPurposive and snowballing sampling were used to recruit study participants for both the observational and face-to-face in-depth interview portions of the study. In total, 25 clinicians and 43 patients participated in this study.ResultsTwo primary thematic categories were identified: (1) circumstances for external engagement; and (2) clinical conditions for engagement. Thematic subcategories included community engagement, scientific engagement, reputational value, experiential information, professional identity, self-awareness of competence, multidisciplinary programmes and situational factors.ConclusionThis study adds new contextual knowledge about the mechanisms that characterise referral decision-making processes and how these impact the meaning of physician relationships, organisation of healthcare delivery and the knowledge and beliefs that physicians have about their colleagues. This study highlights the nuances that influence how new collaborative networks are formed and maintained by detailing how relationships among physicians develop and evolve over time.

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Comparing Teaching Versus Nonteaching Hospitals

Abstract: Major teaching hospitals are significantly more likely to provide care for minorities and patients requiring transfer from other institutions for advanced care.Both are essential to an equitable and high-quality regional health care system.

Cited by 35 publications

References 40 publications

Comparison of Costs of Care for Medicare Patients Hospitalized in Teaching and Nonteaching Hospitals

Comparison of Costs of Care for Medicare Patients Hospitalized in Teaching and Nonteaching Hospitals

Hospital Characteristics Associated With Risk-standardized Readmission Rates

Determinants of physician networks: an ethnographic study examining the processes that inform patterns of collaboration and referral decision-making among physicians

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