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Health Aff (Millwood). 2018 Jun;37(6):864-872. doi: 10.1377/hlthaff.2017.1250.

Do Academic Medical Centers Disproportionately Benefit The Sickest Patients?

Author information

1
Laura Burke is an assistant professor of emergency medicine at Beth Israel Deaconess Medical Center/Harvard Medical School, in Boston, Massachusetts.
2
Dhruv Khullar is a physician at NewYork-Presbyterian Hospital and a researcher in the Department of Healthcare Policy and Research, Weill Cornell Medical Center, in New York City.
3
E. John Orav is an associate professor of biostatistics at the Harvard T. H. Chan School of Public Health, in Cambridge, Massachusetts.
4
Jie Zheng is a senior statistician at the Harvard T. H. Chan School of Public Health.
5
Austin Frakt is director of the Partnered Evidence-Based Policy Resource Center at the Veterans Affairs (VA) Boston Healthcare System; an associate professor in the Boston University School of Public Health; and an adjunct associate professor at the Harvard T. H. Chan School of Public Health.
6
Ashish K. Jha ( ajha@hsph.harvard.edu ) is the K. T. Li Professor of International Health at the Harvard T. H. Chan School of Public Health and director of the Harvard Global Health Institute.

Abstract

Academic medical centers are widely considered to have higher costs than nonteaching hospitals, which has led some policy makers to suggest that the centers should be reserved for patients with the most complex conditions. While prior studies have shown lower mortality at the centers, it is unclear how this varies by patient severity. We examined more than 11.8 million hospitalizations in the period 2012-14 for Medicare beneficiaries ages sixty-five and older and found that, after adjustment for patient and hospital characteristics, high-severity patients had 7 percent lower odds, medium-severity patients had 13 percent lower odds, and low-severity patients had 17 percent lower odds of thirty-day mortality when treated at an academic medical center for common medical conditions, compared to similar patients treated at a nonteaching hospital. For surgical procedures, high-severity patients had 17 percent lower odds of mortality, medium-severity patients had 10 percent lower odds, and there was no difference for low-severity patients. The availability of technology explained some, but not all, of these differences. Taken together, these findings suggest that efforts to limit care at academic medical centers have the potential to lead to worse outcomes, as mortality rates for even low-severity patients seem to be lower at the centers.

KEYWORDS:

Quality Of Care

PMID:
29863940
DOI:
10.1377/hlthaff.2017.1250

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