Illness severity and costs of administration at teaching and nonteaching hospitals

Article Abstract:

Teaching hospitals within the United States have a unique position in the delivery of health care, as they are the institutions where most complex or unusual cases are sent for treatment. Because of the cost of maintaining their reservoir of specialized talent and the financial burden of educating new generations of doctors and other health personnel, these institutions are also given supplemental payments by the Medicare system. As a result the costs associated with treating patients within a tertiary care teaching hospital have been known to be significantly higher than in other classes of hospitals. This difference in cost between teaching and other hospitals has long been associated with both the severity of cases, and with a more complicated and different mix of patients. The present study investigates these assumptions using 15 metropolitan Boston hospitals. In all 4,439 cases with 8 common diagnoses were compared in five tertiary care teaching, five other teaching and five nonteaching hospitals. The patient's physiologic status, diagnosis, and costs were compared between the three situations. There was, however, no attempt to examine the outcome of patients served by the various hospitals. Although the severity of some types of cases at the teaching hospitals was greater, there was little absolute difference in the cases seen at the various classes of hospitals. Eighteen percent of the higher costs at teaching hospitals was attributable to factors such as maintaining the staff and equipment to serve unusual or the occasionally difficult case. These data suggest that with very few exceptions, there are not significant differences in illness in the patients seen by tertiary teaching, other teaching, and nonteaching hospitals. (Consumer Summary produced by Reliance Medical Information, Inc.)

Economic aspects, Prices and rates, Medical care, Cost of, Health care costs, Hospitals, Hospitals, Teaching, Teaching hospitals, Hospital rates

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Minority Faculty and Academic Rank in Medicine

Article Abstract:

Faculty at medical schools who belong to minority groups are less likely to achieve senior rank as a full professor. Researchers surveyed 1,807 faculty members at US medical schools, of whom 1,463 (81.0%) were white, 154 (8.5%) were black, 136 (7.5%) were Asian, and 54 (3%) were Hispanic. Half had achieved senior academic rank, including 30% of the black faculty, 43% of the Asian faculty, 41% of the Hispanic faculty, and 58% of the white faculty. After adjusting for other factors affecting promotion, blacks and Hispanics were 70% less likely to achieve senior rank.

Achievements and awards, Demographic aspects, College faculty, Medical colleges, Academic achievement, Medical school faculty, Ethnic groups, Occupational prestige

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Statewide quality improvement initiatives and mortality after cardiac surgery

Article Abstract:

Cardiac surgery survival rates between 1990 and 1994 improved significantly in states with and without statewide quality improvement initiatives, raising questions about the success of the statewide programs. Mortality rates for northern New England and New York, both with initiatives, and for Massachusetts, without initiatives, showed similar improvements, indicating other causes. Possible causes for mortality rate drops include technological advances, better perioperative care and hospital-level quality improvements.

Mortality, Patient outcomes, Surgery, Heart, Hospital patients, Coronary artery bypass, Heart surgery

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