Patient Complexity, Social Factors, and Hospitalization Outcomes at Academic and Community Hospitals

Area of Science:

• Internal Medicine
• Health Services Research
• Comparative Effectiveness

Background:

• Limited evaluations exist comparing patient care at academic versus community hospitals.
• Understanding these differences is crucial for designing clinical models, remuneration, and training programs.

Purpose of the Study:

• To evaluate differences in patient complexity and clinical outcomes between academic and community hospitals for general medicine admissions.

Main Methods:

• Retrospective cohort study of over 947,000 general medicine admissions across 28 Ontario, Canada hospitals (April 2015-December 2021).
• Compared demographic, clinical, and social characteristics, alongside outcomes like mortality, length of stay, and readmission rates.
• Utilized multivariable regression analysis adjusting for baseline factors.

Main Results:

• Baseline clinical and social characteristics were similar between academic and community hospitals.
• Patient volumes per physician were higher in academic settings.
• No significant differences were found in mortality or intensive care unit admission rates.
• Readmission rates at 7 and 30 days were significantly higher in academic hospitals.

Conclusions:

• Patients admitted to general medicine at academic and community hospitals share similar baseline characteristics and clinical outcomes.
• Higher readmission rates at academic hospitals warrant further investigation into post-discharge care strategies.
• The findings support the representativeness of academic hospital case mix for general internal medicine residency training.