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American Journal of Public Health logoLink to American Journal of Public Health
. 1990 Sep;80(9):1095–1100. doi: 10.2105/ajph.80.9.1095

Teaching status and resource use for patients with acute myocardial infarction: a new look at the indirect costs of graduate medical education.

I S Udvarhelyi 1, T Rosborough 1, R P Lofgren 1, N Lurie 1, A M Epstein 1
PMCID: PMC1404856  PMID: 2382747

Abstract

To investigate whether the process of graduate medical education increases costs in teaching hospitals by causing longer lengths of stay and greater resource use, we compared lengths of stay, hospital charges, and the use of cardiovascular procedures for patients with acute myocardial infarction admitted to the teaching and nonteaching services of a university-affiliated community hospital. After adjusting for severity of illness and demographic characteristics, patients on the teaching services had a mean length of stay that was shorter by 0.6 days (p = 0.04) and mean charges that were $2,060 lower (p = 0.15) than for patients on the nonteaching service. Patients on the teaching service also had 15 percent (95% CI: -26, -4) fewer cardiac catheterizations and 9 percent (-18, 0) fewer procedures for myocardial revascularization (angioplasty or cardiac bypass surgery). These findings suggest that graduate medical education per se may not directly increase the use of health care resources and that the cost differences between teaching and nonteaching hospitals may be largely a consequence of other factors. These factors may include epiphenomena of teaching such as a specialized organizational structure, specialized patient care services, and continuing medical education for the nursing and medical staffs. They may also include factors not related to teaching such as differences in patients' severity of illness and sociodemographic characteristics.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Becker E. R., Sloan F. A. Utilization of hospital services: the roles of teaching, case mix, and reimbursement. Inquiry. 1983 Fall;20(3):248–257. [PubMed] [Google Scholar]
  2. Buchwald D., Komaroff A. L., Cook E. F., Epstein A. M. Indirect costs for medical education. Is there a July phenomenon? Arch Intern Med. 1989 Apr;149(4):765–768. [PubMed] [Google Scholar]
  3. Cameron J. M. The indirect costs of graduate medical education. N Engl J Med. 1985 May 9;312(19):1233–1238. doi: 10.1056/NEJM198505093121906. [DOI] [PubMed] [Google Scholar]
  4. Detsky A. S., McLaughlin J. R., Abrams H. B., L'Abbe K., Markel F. M. Do interns and residents order more tests than attending staff? Results of a house staff strike. Med Care. 1986 Jun;24(6):526–534. doi: 10.1097/00005650-198606000-00007. [DOI] [PubMed] [Google Scholar]
  5. Epstein A. M., Stern R. S., Tognetti J., Begg C. B., Hartley R. M., Cumella E., Jr, Ayanian J. Z. The association of patients' socioeconomic characteristics with the length of hospital stay and hospital charges within diagnosis-related groups. N Engl J Med. 1988 Jun 16;318(24):1579–1585. doi: 10.1056/NEJM198806163182405. [DOI] [PubMed] [Google Scholar]
  6. Frick A. P., Martin S. G., Shwartz M. Case-mix and cost differences between teaching and nonteaching hospitals. Med Care. 1985 Apr;23(4):283–295. doi: 10.1097/00005650-198504000-00001. [DOI] [PubMed] [Google Scholar]
  7. Garber A. M., Fuchs V. R., Silverman J. F. Case mix, costs, and outcomes. Differences between faculty and community services in a university hospital. N Engl J Med. 1984 May 10;310(19):1231–1237. doi: 10.1056/NEJM198405103101906. [DOI] [PubMed] [Google Scholar]
  8. Garg M. L., Elkhatib M., Kleinberg W. M., Mulligan J. L. Reimbursing for residency training: how many times? Med Care. 1982 Jul;20(7):719–726. doi: 10.1097/00005650-198207000-00007. [DOI] [PubMed] [Google Scholar]
  9. Gertman P. M., Stackpole D. A., Levenson D. K., Manuel B. M., Brennan R. J., Janko G. M. Second opinions for elective surgery. The mandatory medicaid program in Massachusetts. N Engl J Med. 1980 May 22;302(21):1169–1174. doi: 10.1056/NEJM198005223022103. [DOI] [PubMed] [Google Scholar]
  10. Goldfarb M. G., Coffey R. M. Case-mix differences between teaching and nonteaching hospitals. Inquiry. 1987 Spring;24(1):68–84. [PubMed] [Google Scholar]
  11. Horn S. D. Measuring severity of illness: comparisons across institutions. Am J Public Health. 1983 Jan;73(1):25–31. doi: 10.2105/ajph.73.1.25. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Horn S. D., Sharkey P. D. Measuring severity of illness to predict patient resource use within DRGs. Inquiry. 1983 Winter;20(4):314–321. [PubMed] [Google Scholar]
  13. Jencks S. F., Bobula J. D. Does receiving referral and transfer patients make hospitals expensive? Med Care. 1988 Oct;26(10):948–958. doi: 10.1097/00005650-198810000-00003. [DOI] [PubMed] [Google Scholar]
  14. Jones K. R. Predicting hospital charge and stay variation. The role of patient teaching status, controlling for diagnosis-related group, demographic characteristics, and severity of illness. Med Care. 1985 Mar;23(3):220–235. [PubMed] [Google Scholar]
  15. Jones K. R. The influence of the attending physician on indirect graduate medical education costs. J Med Educ. 1984 Oct;59(10):789–798. doi: 10.1097/00001888-198410000-00003. [DOI] [PubMed] [Google Scholar]
  16. Knaus W. A., Draper E. A., Wagner D. P., Zimmerman J. E. APACHE II: a severity of disease classification system. Crit Care Med. 1985 Oct;13(10):818–829. [PubMed] [Google Scholar]
  17. Martin S. G., Shwartz M., Whalen B. J., D'Arpa D., Ljung G. M., Thorne J. H., McKusick A. E. Impact of a mandatory second-opinion program on medicaid surgery rates. Med Care. 1982 Jan;20(1):21–45. doi: 10.1097/00005650-198201000-00003. [DOI] [PubMed] [Google Scholar]
  18. Martz E. W., Ptakowski R. Educational costs to hospitalized patients. J Med Educ. 1978 May;53(5):383–386. doi: 10.1097/00001888-197805000-00002. [DOI] [PubMed] [Google Scholar]
  19. Schroeder S. A., O'Leary D. S. Differences in laboratory use and length of stay between university and community hospitals. J Med Educ. 1977 May;52(5):418–420. doi: 10.1097/00001888-197705000-00008. [DOI] [PubMed] [Google Scholar]

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