• Jeffrey H Silber, Paul R Rosenbaum, Bijan A Niknam, Richard N Ross, Joseph G Reiter, Alexander S Hill, Lauren L Hochman, Sydney E Brown, Alexander F Arriaga, and Lee A Fleisher.
• Center for Outcomes Research, , Children's Hospital of Philadelphia, Philadelphia, PA, USA. silber@email.chop.edu.
• J Gen Intern Med. 2020 Mar 1; 35 (3): 743-752.

BackgroundTeaching hospitals typically pioneer investment in new technology and cultivate workforce characteristics generally associated with better quality, but the value of this extra investment is unclear.ObjectiveCompare outcomes and costs between major teaching and non-teaching hospitals by closely matching on patient characteristics.DesignMedicare patients at 339 major teaching hospitals (resident-to-bed (RTB) ratios ≥ 0.25); matched patient controls from 2439 non-teaching hospitals (RTB ratios < 0.05).ParticipantsForty-three thousand nine hundred ninety pairs of patients (one from a major teaching hospital and one from a non-teaching hospital) admitted for acute myocardial infarction (AMI), 84,985 pairs admitted for heart failure (HF), and 74,947 pairs admitted for pneumonia (PNA).ExposureTreatment at major teaching hospitals versus non-teaching hospitals.Main MeasuresThirty-day all-cause mortality, readmissions, ICU utilization, costs, payments, and value expressed as extra cost for a 1% improvement in survival.Key ResultsThirty-day mortality was lower in teaching than non-teaching hospitals (10.7% versus 12.0%, difference = - 1.3%, P < 0.0001). The paired cost difference (teaching - non-teaching) was $273 (P < 0.0001), yielding $211 per 1% mortality improvement. For the quintile of pairs with highest risk on admission, mortality differences were larger (24.6% versus 27.6%, difference = - 3.0%, P < 0.0001), and paired cost difference = $1289 (P < 0.0001), yielding $427 per 1% mortality improvement at 30 days. Readmissions and ICU utilization were lower in teaching hospitals (both P < 0.0001), but length of stay was longer (5.5 versus 5.1 days, P < 0.0001). Finally, individual results for AMI, HF, and PNA showed similar findings as in the combined results.Conclusions And RelevanceAmong Medicare patients admitted for common medical conditions, as admission risk of mortality increased, the absolute mortality benefit of treatment at teaching hospitals also increased, though accompanied by marginally higher cost. Major teaching hospitals appear to return good value for the extra resources used.

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