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Despite goals, less experience, teaching hospitals offer similar IBD outcomes
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Although there are some differences between teaching and non-teaching hospitals in terms of metrics of cost-effective patient care, the disparity is driven by disease severity and not the addition of an academic mission, according to study results.
Gary R. Lichtenstein, MD, of the Perelman Center for Advanced Medicine at the University of Pennsylvania, and colleagues wrote in Inflammatory Bowel Diseases that patients with more medical complexities are often referred to teaching hospitals, but little research has focused on the impact of teaching status on IBD outcomes.
“However, [teaching hospitals] commonly train less experienced physicians, many of whom play a significant role in patient care,” they wrote. “This teaching aspect has an unclear effect on outcomes.”
Researchers used the Vizient clinical database to identify patients hospitalized for IBD between 2014 and 2018. They grouped patients based on hospital status; major teaching hospital, minor teaching hospital and non-teaching hospital. They analyzed aggregated discharge data to determine if teaching status was associated with mean length of stay, mean direct cost, 30-day readmission rate and in-hospital mortality rate.
The database included information from 291 hospitals and 29,863 discharges for ulcerative colitis and 314 hospitals and 62,698 discharges for Crohn’s disease.
Looking at unadjusted data, researchers found that length of stay, cost and readmission were all greater among teaching hospitals for UC and CD, while mortality rate was only higher for UC. However, these associations were mostly eliminated after controlling for patient demographics, disease severity and hospital characteristics.
After they controlled for disease severity, investigators identified only an increased 30-day readmission rate (1.98%; 95% CI, 0.33%–3.61%). There was no difference among the other remaining outcomes in major teaching hospitals in both UC and CD.
Lichtenstein and colleagues wrote that their findings show that teaching hospitals do not suffer when compared with community centers despite the amount of resources they put toward training and research.
“Treatment at academic facilities with more specialized expertise and resources for management of complex IBD should therefore remain an option for patients under all insurance networks, and exclusion should not be based on unadjusted cost data alone,” they wrote. “Additional studies are needed to better characterize the factors that drive increased resource utilization in order to provide high-value inpatient IBD care at all medical centers.” – by Alex Young
Disclosures: Lichtenstein reports receiving compensation for research/grant support, support for lectures and supports for scientific advisory committee participation from Abbott, Axcan, Bristol Meyers Squibb, Elan, Prometheus and UCB. Please see the full study for all other authors’ relevant financial disclosures.
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