Academic health centers often have a glowing reputation among clinicians and the general public of being the best of the best. In many cases, simple analysis of the numbers does not seem to back this assertion up. Part of the reason is selection bias. Academic and community health centers do not treat the same types of patients. The sickest and most severely ill patients often head to the specialists at academic health centers. So one key question is, if we can control for observable factors, do academic health centers do better?
Well, it turns out that depends on what “better” means. For CMS and many payers, better means lower 30-day readmission rates. For most patients, however, better means lower 30-day mortality rates. It turns out that academic health centers don’t perform particularly well on the 30-day readmission metric, but do very well on the mortality measure.
A paper by Shahian et al. (2020) uses Medicare claims data from 2013 to 2014. They classify hospitals into one of three categories: (i) Council of Teaching Hospitals and Health Systems (COTH) major teaching hospitals, (ii) non‐COTH teaching hospitals, and (iii) nonteaching hospitals. Using this approach they find that:
Averaged across deciles, adjusted 30‐day COTH hospital readmission rates were, on a relative scale ([COTH minus nonteaching] ÷ nonteaching), 1.63 percent higher (95% CI: 0.89 percent, 2.25 percent) than at nonteaching hospitals, but their average adjusted 30‐day postdischarge mortality rates were 11.55 percent lower (95% CI: −13.78 percent, −9.37 percent). Penalized COTH hospitals had the highest readmission rates of all categories (23.99 percent [95% CI: 23.50 percent, 24.49 percent]) but the lowest 30‐day postdischarge mortality (8.30 percent [95% CI: 7.99 percent, 8.57 percent] vs 9.84 percent [95% CI: 9.69 percent, 9.99 percent] for nonpenalized, nonteaching hospitals).
In short, despite the poor readmission rates score, if you are a patient, you’d rather go to the academic health center.
- Shahian DM, Liu X, Mort EA, Normand SL. The association of hospital teaching intensity with 30‐day postdischarge heart failure readmission and mortality rates. Health Services Research. 2020 Jan 9.