Do Academic Medical Centers Disproportionately Benefit The Sickest Patients?

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...

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Bibliographic Details
Published in:Health Affairs 2018-06, Vol.37 (6), p.864-872
Main Authors: Burke, Laura, Khullar, Dhruv, Orav, E. John, Zheng, Jie, Frakt, Austin, Jha, Ashish K.
Format: Article
Language:English
Subjects:
Age
Aneurysms
Aortic aneurysms
Beneficiaries
Chronic illnesses
Costs
Ethnicity
Health care expenditures
Health care facilities
Health care policy
Heart attacks
Hospitalization
Hospitals
Medicaid
Medical conditions
Medicare
Mortality
Mortality rates
Nonprofit organizations
Patients
Policy making
Sepsis
Severity
Socioeconomic factors
Socioeconomic status
Stroke
Teaching hospitals
Technology
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Summary: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.
ISSN:0278-2715
1544-5208
DOI:10.1377/hlthaff.2017.1250