September 13, 2000
BIRMINGHAM, AL — Teaching hospitals provide better quality of care to elderly heart attack patients than non-teaching hospitals, according to a study by researchers at the University of Alabama at Birmingham (UAB). Details of the study comparing quality of care and mortality of patients in relation to teaching hospital status will be published in this week's issue of the Journal of the American Medical Association.
“Major teaching hospitals, those with more than one intern for every 10 patients, did better than minor teaching hospitals, which did better than non-teaching hospitals, in providing quality care based on prescribing the most appropriate therapies to heart attack patients,” says Dr. Robert Centor, professor and associate dean of medicine with the division of general and internal medicine at UAB.
The study, funded by the Agency for Healthcare Research and Quality, reviewed the case histories of 114,129 Medicare patients, ages 65 and older, from across the country that had been hospitalized between 1994 and 1995 for a heart attack. “Patients discharged from teaching hospitals were 4 to 5 percent more likely to be alive two years later,” says Centor. “This is directly attributable to teaching hospitals providing a better quality of care.”
The study found teaching hospitals were more likely to give patients aspirin when appropriate, during their hospital stays and were more likely to give patients beta-blockers and ACE inhibitors, when appropriate, upon discharge from the hospital.
Aspirin is given to help prevent blood clots, beta-blockers to slow the heart rate and reduce contractions of the heart muscle, and ACE inhibitors to reduce constriction of the blood vessels.
“In the administration of aggressive first-line therapies such as angioplasty, there was no real difference between teaching and non-teaching hospitals,” says Centor. “The difference was in the administration of second-line preventive therapies.”
What accounts for the difference in quality of care is unclear. “It may be that teaching hospitals do better because they use these therapies more often,” says Centor. “Also, in a teaching hospital, with physicians and interns treating patients, there are more checks and balances.”
The findings have important implications for the medical community. “Physicians have a responsibility to be up-to-date on treatments and to know when treatments are clearly indicated as appropriate therapy,” says Centor. “We need to do a better job of diffusing information to physicians to ensure they are equipped to provide the highest level of care.”
Other researchers involved with the study include Dr. Jeroan Allison, UAB assistant professor of internal medicine; Dr. Catarina Kiefe, UAB professor of preventive medicine; Norman Weissman, Ph.D, UAB professor of health administration; and Sharina Person, Ph.D., UAB assistant professor of preventive medicine.