The distinction between quality of care at teaching and non-teaching hospitals has been a subject deliberated on time and time again. Recent research conducted by the Harvard T.H. Chan School of Public Health might just prove that teaching hospitals reign superior in this matter.

58,000 lives can be saved each year

21.5 million Medicare records from patients aged 65 years old and above at 4,483 hospitals across the United States were gathered and analysed. 250 major teaching hospitals, 894 minor teaching hospitals and 3,339 non-teaching hospitals took part in this study between 2012 and 2014.

The research mainly investigated the 30-day mortality rates for 15 common medical conditions such as congestive heart failure, pneumonia and stroke as well as for six surgical procedures including coronary artery bypass grafting, colectomy and hip replacement.

The study found that the 30-day mortality rate was 8.3% at major teaching hospitals, 9.2% at minor teaching hospitals and 9.5% at non-teaching hospitals.

This essentially means that one fewer patient dies for every 83 patients the hospitals see, said one of the study authors, Dr. Laura Burke. When translated to annual statistics, 58,000 lives can be saved a year across the country.

Results remained the same after researchers adjusted for patient characteristics such as age and severity of illness as well as hospital characteristics such as size and profit status. Besides that, major teaching hospitals also recorded lower seven-day and 90-day mortality rates, 0.3% and 1.6% respectively, compared to non-teaching hospitals.

Wide range of conditions seen in public hospitals

“While we know that teaching hospitals fulfil an important mission around teaching and research, we have known less about the quality of care they provide,” said Ashish Jha, professor at the Harvard Chan School and senior author of the study.

“We find that across a very wide range of medical and surgical conditions, patient receiving care at teaching hospitals have superior outcomes,” she stated.

Authors of the study contemplated reasons why the teaching status could be linked with lower mortality rates. One reason was the possibility of teaching hospitals possessing more experience in dealing with particular conditions.

Moreover, these hospitals could have adopted the latest technologies and treatments earlier than non-teaching hospitals for better management outcomes. However, more studies are required to fully understand the association in this subject.

Replicating similar facilities in non-teaching hospitals

Burke elaborated on the advantages of teaching hospitals, “Academic medical centres provide a unique environment, with 24-hour availability of specialty services, advanced technologies, and some of the most expert physicians in the country.”

“This seems to pay off for patients,” she continued. “While obviously not all patients can receive care in major teaching hospitals, understanding which strategies and resources are particularly important to patient outcomes, and how they can be replicated among non-teaching hospitals, is critically important to improve care for all patients.”

Locally, advancements in virtual reality technology and online learning platforms in Singapore’s teaching hospitals substantiate the advantages it has over non-teaching hospitals. Malaysia’s subsidised costs at teaching hospitals are also a major pulling factor for the general public.

However, many patients still believe non-teaching hospitals are better due to the lack of queues, longer patient-doctor interaction times and relatively newer facilities. Studies investigating the differences in mortality rates at both types of hospitals here have yet to be carried out on a large scale. MIMS

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