The Relationship of Hospital Ownership and Teaching Status to 30- and 180-Day Adjusted Mortality Rates

Kuhn, Evelyn M.; Hartz, Arthur J.; Krakauer, Henry; Bailey, R. Clifton; Rimm, Alfred A.

doi:10.1097/00005650-199411000-00003

Cited by 49 publications

(28 citation statements)

References 3 publications

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“…Lastly, because the study was performed at a single institution, the results may not be applicable to patient populations other than those admitted to a public teaching hospital. A previous study looking at adjusted mortality rates based on hospital ownership and teaching status showed an increased risk of death in the 6 months after discharge for patients admitted for all causes to public teaching hospitals, when compared to several other hospital types [25]. Once adjusted for patient risk, however, this difference in mortality accounted for only 9 more patients per 1,000 when compared to hospitals having the best outcomes, indicating hospital type likely does not have a significant impact on long-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Survival after Hospitalization for Community-Acquired and Healthcare-Associated Pneumonia

et al. 2009

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Background: Elderly patients surviving community-acquired pneumonia (CAP) have subsequent increased mortality. However, little is known regarding long-term survival in younger adults or those with healthcare-associated pneumonia (HCAP). Objectives: To identify factors associated with mortality and compare long-term survival in patients hospitalized with HCAP to that of patients with CAP. Methods: We determined survival after discharge as of December 2002 in a patient cohort admitted with pneumonia between June 1994 and May 1996. We used the Cox proportional hazard model to estimate differences in survival after controlling for confounders. Results: Of the 522 patients hospitalized with pneumonia, 457 survived to discharge. One hundred sixty-four patients (36%, 95% confidence interval, CI, 31–40%) were admitted with HCAP, while 293 (64%, 95% CI 60–69%) were admitted with CAP. Of the 181 deaths in the follow-up period, 70 occurred in patients under age 65 years admitted with HCAP (53% death rate, 95% CI 44–62%). Nineteen of these deaths (27%, 95% CI 17–39%) occurred in the absence of HIV infection. In patients under the age of 65 whose only risk factor for HCAP was treatment for pneumonia or hospitalization in the previous 90 days, 4 of 13 patients (31%, 95% CI 9–61%) died. Twenty percent (95% CI 15–26%) of patients under age 65 years admitted with CAP died during the follow-up. Conclusions: Admission for HCAP, and to a lesser degree CAP, is associated with increased long-term mortality even in young patients. Future studies are warranted to identify interventions to improve survival in this population.

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Section: Discussionmentioning

confidence: 99%

Long-Term Survival after Hospitalization for Community-Acquired and Healthcare-Associated Pneumonia

et al. 2009

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“…There is a broad literature exploring whether there are differences in the process and outcomes at academic health centers (AHC), accredited centers of excellence, teaching hospitals and the National Cancer Institute's Comprehensive Cancer Centers (NCICCC). [8][9][10][11][12][13][14][15] Results of these analyses have been mixed. For example, using the national Medicare database, Birkmeyer et al 9 conducted an analysis of 51 NCICCC and 6 cancer procedures.…”

Section: Introductionmentioning

confidence: 99%

The impact of center accreditation on hematopoietic cell transplantation (HCT)

Marmor

Begun

Abraham

et al. 2014

Bone Marrow Transplant

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There are two voluntary center-accrediting organizations in the USA, the Foundation for the Accreditation of Cellular Therapy (FACT) and core Clinical Trial Network (CTN) certification, that are thought to improve and ensure hematopoietic cell transplantation (HCT) center quality care and certify clinical excellence. We sought to observe whether there are differences in outcomes between HLA-matched and -mismatched HCT by CTN and FACT status. Using the 2008-2010 Center for International Blood & Marrow Transplant Research data we created three center categories: non-FACT centers (24 centers), FACT-only certified centers (106 centers) and FACT and core clinical trial network (FACT/CTN) certified centers (32 centers). We identified patient characteristics within these centers and the relationship between FACT certification and survival. Our cohort consisted of 12 993 transplants conducted in 162 centers. After adjusting for patient and center characteristics we found that FACT/CTN centers had consistently superior results relative to non-FACT and FACT-only centers (P<0.05) especially for more complex HCT. However, non-FACT centers were comparable to FACT-only centers for matched related and unrelated patients. Although FACT status is an important standard of quality control that begins to define improved OS, our results indicate that FACT status alone is not an indicator for superior outcomes.

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“…Public hospitals have a higher problem rate than private hospitals (Kuhn et al, 1991) and an increased percentage of adverse events due to negligence (Hartz et al, 1989;Brennan et al, 1991). Studies focusing on hospital type show that a not-forprofit teaching hospital had the lowest mortality rate, whereas a public teaching hospital had the highest risk-adjusted mortality rate and longer length of stay (Kuhn et al, 1994;Yuan et al, 2000). This association was strongest when the hospital served a large community, >2.5 million people (Kuhn et al, 1994).…”

Section: Discussionmentioning

confidence: 99%

Medical education in the public versus the private setting: a qualitative study of medical students’ attitudes

Maa

McCullough

2006

Medical Teacher

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Public hospitals serve as primary training sites for medical students. Public patients may therefore bear a disproportionate burden of medical student education. The purpose of this study was to critically examine the ethics of medical education in the public setting. Attitudes of first- and fourth-year students towards the role of public patients in medical education were elicited in focus groups. Inductive qualitative analysis was utilized to organize data into conceptual groups, which were then analyzed within an ethical framework. All patients have an equal obligation to participate in medical education. Students identified modifying factors that could affect a patient's obligation to educate future physicians. Available data highlight a concern that public teaching hospitals may provide a lower quality of care. If true, then the public teaching setting is creating an unfair burden upon that patient population who would then have a weakened obligation to participate in medical education.

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The Relationship of Hospital Ownership and Teaching Status to 30- and 180-Day Adjusted Mortality Rates

Cited by 49 publications

References 3 publications

Long-Term Survival after Hospitalization for Community-Acquired and Healthcare-Associated Pneumonia

Long-Term Survival after Hospitalization for Community-Acquired and Healthcare-Associated Pneumonia

The impact of center accreditation on hematopoietic cell transplantation (HCT)

Medical education in the public versus the private setting: a qualitative study of medical students’ attitudes

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