Differences in healthcare outcomes between teaching and non teaching hospitals for patients with delirium: a retrospective cohort study

Susrutha Kotwal, Marwan S. Abougergi, Scott Wright

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The physician workforce at teaching hospitals differs compared to non-teaching hospitals, and data suggest that patient outcomes may also be dissimilar. Delirium is a common, costly disorder among hospitalized patients and approaches to care are not standardized. OBJECTIVE: This study set out to explore differences in healthcare outcomes between teaching and non-teaching hospitals for patients admitted with delirium. DESIGN: Retrospective cohort analysis. SETTING AND PARTICIPANTS: We used the 2014 Nationwide Inpatient Sample database. Adult patients (≥18 years of age) hospitalized in acute-care hospitals in the USA with delirium (defined with ICD-9 code) were studied. MAIN OUTCOME MEASURES: The primary outcome was in-hospital all-cause mortality. Secondary outcomes were discharge status and several measures of healthcare resource utilization: length of stay, total hospitalization costs and multiple procedures performed. RESULTS: In 2014, out of 57 460 adult patients admitted to hospitals with delirium, 58.4% were hospitalized at teaching hospitals and the remainder 41.6% at non-teaching hospitals. The in-hospital mortality of delirium patients in teaching hospitals was 1.33% (95% CI 1.08%-1.63%), and 1.26% (95% CI 0.97%-1.63%) in non-teaching hospitals. The mean total hospital costs were $7642 (95% CI 7384-7900) in teaching hospitals, and $6650 (95% CI 6460-6840) in non-teaching hospitals. After adjustment for confounders, total hospitalization costs were statistically significantly different between the hospitals types-with non-teaching providing less expensive care. CONCLUSIONS: Patients with delirium admitted to non-teaching hospitals had comparable clinical and process outcomes achieved at lower costs. Further research can be conducted to explore the contextual issues and reasons for these differences in healthcare costs.

Original languageEnglish (US)
Pages (from-to)378-384
Number of pages7
JournalInternational journal for quality in health care : journal of the International Society for Quality in Health Care
Volume31
Issue number5
DOIs
StatePublished - Jun 1 2019

Fingerprint

Delirium
Teaching Hospitals
Teaching
Cohort Studies
Retrospective Studies
Delivery of Health Care
International Classification of Diseases
Costs and Cost Analysis
Hospitalization
Hospital Costs
Hospital Mortality
Health Care Costs
Inpatients
Length of Stay
Databases
Physicians
Mortality

Keywords

  • delirium
  • healthcare utilization
  • teaching/non-teaching hospital

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

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title = "Differences in healthcare outcomes between teaching and non teaching hospitals for patients with delirium: a retrospective cohort study",
abstract = "BACKGROUND: The physician workforce at teaching hospitals differs compared to non-teaching hospitals, and data suggest that patient outcomes may also be dissimilar. Delirium is a common, costly disorder among hospitalized patients and approaches to care are not standardized. OBJECTIVE: This study set out to explore differences in healthcare outcomes between teaching and non-teaching hospitals for patients admitted with delirium. DESIGN: Retrospective cohort analysis. SETTING AND PARTICIPANTS: We used the 2014 Nationwide Inpatient Sample database. Adult patients (≥18 years of age) hospitalized in acute-care hospitals in the USA with delirium (defined with ICD-9 code) were studied. MAIN OUTCOME MEASURES: The primary outcome was in-hospital all-cause mortality. Secondary outcomes were discharge status and several measures of healthcare resource utilization: length of stay, total hospitalization costs and multiple procedures performed. RESULTS: In 2014, out of 57 460 adult patients admitted to hospitals with delirium, 58.4{\%} were hospitalized at teaching hospitals and the remainder 41.6{\%} at non-teaching hospitals. The in-hospital mortality of delirium patients in teaching hospitals was 1.33{\%} (95{\%} CI 1.08{\%}-1.63{\%}), and 1.26{\%} (95{\%} CI 0.97{\%}-1.63{\%}) in non-teaching hospitals. The mean total hospital costs were $7642 (95{\%} CI 7384-7900) in teaching hospitals, and $6650 (95{\%} CI 6460-6840) in non-teaching hospitals. After adjustment for confounders, total hospitalization costs were statistically significantly different between the hospitals types-with non-teaching providing less expensive care. CONCLUSIONS: Patients with delirium admitted to non-teaching hospitals had comparable clinical and process outcomes achieved at lower costs. Further research can be conducted to explore the contextual issues and reasons for these differences in healthcare costs.",
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T1 - Differences in healthcare outcomes between teaching and non teaching hospitals for patients with delirium

T2 - a retrospective cohort study

AU - Kotwal, Susrutha

AU - Abougergi, Marwan S.

AU - Wright, Scott

PY - 2019/6/1

Y1 - 2019/6/1

N2 - BACKGROUND: The physician workforce at teaching hospitals differs compared to non-teaching hospitals, and data suggest that patient outcomes may also be dissimilar. Delirium is a common, costly disorder among hospitalized patients and approaches to care are not standardized. OBJECTIVE: This study set out to explore differences in healthcare outcomes between teaching and non-teaching hospitals for patients admitted with delirium. DESIGN: Retrospective cohort analysis. SETTING AND PARTICIPANTS: We used the 2014 Nationwide Inpatient Sample database. Adult patients (≥18 years of age) hospitalized in acute-care hospitals in the USA with delirium (defined with ICD-9 code) were studied. MAIN OUTCOME MEASURES: The primary outcome was in-hospital all-cause mortality. Secondary outcomes were discharge status and several measures of healthcare resource utilization: length of stay, total hospitalization costs and multiple procedures performed. RESULTS: In 2014, out of 57 460 adult patients admitted to hospitals with delirium, 58.4% were hospitalized at teaching hospitals and the remainder 41.6% at non-teaching hospitals. The in-hospital mortality of delirium patients in teaching hospitals was 1.33% (95% CI 1.08%-1.63%), and 1.26% (95% CI 0.97%-1.63%) in non-teaching hospitals. The mean total hospital costs were $7642 (95% CI 7384-7900) in teaching hospitals, and $6650 (95% CI 6460-6840) in non-teaching hospitals. After adjustment for confounders, total hospitalization costs were statistically significantly different between the hospitals types-with non-teaching providing less expensive care. CONCLUSIONS: Patients with delirium admitted to non-teaching hospitals had comparable clinical and process outcomes achieved at lower costs. Further research can be conducted to explore the contextual issues and reasons for these differences in healthcare costs.

AB - BACKGROUND: The physician workforce at teaching hospitals differs compared to non-teaching hospitals, and data suggest that patient outcomes may also be dissimilar. Delirium is a common, costly disorder among hospitalized patients and approaches to care are not standardized. OBJECTIVE: This study set out to explore differences in healthcare outcomes between teaching and non-teaching hospitals for patients admitted with delirium. DESIGN: Retrospective cohort analysis. SETTING AND PARTICIPANTS: We used the 2014 Nationwide Inpatient Sample database. Adult patients (≥18 years of age) hospitalized in acute-care hospitals in the USA with delirium (defined with ICD-9 code) were studied. MAIN OUTCOME MEASURES: The primary outcome was in-hospital all-cause mortality. Secondary outcomes were discharge status and several measures of healthcare resource utilization: length of stay, total hospitalization costs and multiple procedures performed. RESULTS: In 2014, out of 57 460 adult patients admitted to hospitals with delirium, 58.4% were hospitalized at teaching hospitals and the remainder 41.6% at non-teaching hospitals. The in-hospital mortality of delirium patients in teaching hospitals was 1.33% (95% CI 1.08%-1.63%), and 1.26% (95% CI 0.97%-1.63%) in non-teaching hospitals. The mean total hospital costs were $7642 (95% CI 7384-7900) in teaching hospitals, and $6650 (95% CI 6460-6840) in non-teaching hospitals. After adjustment for confounders, total hospitalization costs were statistically significantly different between the hospitals types-with non-teaching providing less expensive care. CONCLUSIONS: Patients with delirium admitted to non-teaching hospitals had comparable clinical and process outcomes achieved at lower costs. Further research can be conducted to explore the contextual issues and reasons for these differences in healthcare costs.

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KW - healthcare utilization

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