Do Academic Medical Centers Disproportionately Benefit The Sickest Patients?

Area of Science:

• Healthcare research
• Hospital administration
• Patient outcomes

Background:

• Academic medical centers (AMCs) are perceived as high-cost institutions.
• Policy proposals suggest restricting AMC care to complex cases.
• Previous research indicates lower mortality at AMCs, but variation by patient severity is unclear.

Purpose of the Study:

• To investigate the association between hospital type (AMC vs. nonteaching) and 30-day mortality across different patient severity levels.
• To determine if the benefits of AMCs extend to lower-severity patients.

Main Methods:

• Analysis of over 11.8 million hospitalizations for Medicare beneficiaries (age 65+) from 2012-2014.
• Statistical adjustment for patient and hospital characteristics.
• Comparison of mortality rates for common medical conditions and surgical procedures between AMCs and nonteaching hospitals.

Main Results:

• For common medical conditions, AMCs showed lower 30-day mortality across all severity levels: 7% lower for high-severity, 13% for medium-severity, and 17% for low-severity patients.
• For surgical procedures, AMCs demonstrated lower mortality for high-severity (17% lower) and medium-severity (10% lower) patients, with no significant difference for low-severity patients.
• Technological availability partially explained these observed differences.

Conclusions:

• Academic medical centers provide a mortality benefit for patients across the spectrum of severity for common medical conditions.
• The findings challenge the notion of restricting AMC care to only the most complex cases.
• Limiting access to AMCs could potentially lead to poorer patient outcomes, even for less severe conditions.