Similar patient characteristics and hospital outcomes at community and academic hospitals

1. In this retrospective cohort study of patients admitted to general medicine wards at hospitals across Ontario, Canada, community and academic hospitals had similar baseline clinical characteristics, social characteristics, and hospital outcomes. 

2. Academic hospitals had higher 7- and 30-day readmission rates compared to community hospitals. 

Evidence Rating Level: 2 (Good)

Study Rundown: Academic and community hospitals both provide essential services to their populations. Academic hospitals focus on a combination of research and educating health care professionals, along with providing patient care.  While community hospitals focus on providing medical care to a larger population while playing a growing role in research. Although they have different priorities, it is unclear whether they care for different types of patients. To address this gap in research, a retrospective cohort study was conducted at 28 hospitals across Ontario, Canada. To distinguish the types of hospitals, academic hospitals were those affiliated with a medical school, while community hospitals were not. Patient records were deidentified and transferred from the hospitals in this study to a central site where they were processed. Several outcomes were measured at each hospital including baseline characteristics, social characteristics, and clinical processes (such as in-hospital mortality and readmission rates). The baseline clinical characteristics, including the proportion of females, and social characteristics, including income, were similar at both hospitals. A fault of the Canadian healthcare system is that the hospitals do not collect all sociodemographic data at the patient level, so this study had to rely on neighbourhood-level data. Overall, patients admitted to general medicine wards at either academic or community hospitals had similar baseline characteristics, and outcomes, with readmission rates being higher at academic hospitals. It is particularly important that residents training at academic settings sees a representative population they would encounter at community hospitals. 

Click here to read the study in JAMA Network Open

Relevant Reading: Association of academic medical center presence with clinical outcomes at neighboring community hospitals among Medicare beneficiaries   

In-Depth [retrospective cohort]: To understand if there were different patient characteristics at academic and community hospitals, this retrospective cohort study was created. Inclusion criteria included all patients 18 years or older, who were admitted to or discharged from general medicine. This includes emergency and direct department admissions. The cohort was compiled of 609 696 admissions at 17 community hospitals (median [IQR] age, 73 [58-84] years) and 337 374 admissions at 11 academic hospitals (median [IQR] age, 70 [56-82] years), adding up to a total cohort of 947 070 admissions. The academic hospitals had a greater proportion of patients per general medicine physician compared to the community hospitals (20 [19-22] vs 17 IQR [15-19]; SMD=1.086). Social characteristics such as income, and education, were similar between the two hospitals. Similarly, baseline clinical characteristics were not statistically different between community and academic hospitals, including female sex (307 381 [50.4%] vs 168 033 [49.8%]; standardized mean difference [SMD] = 0.012). After adjusting for baseline characteristics, community and academic sites had similar in-hospital mortality (adjusted OR [aOR], 0.96; 95% CI, 0.78 to 1.17), length of stay (LOS) (β=-0.001; 95% CI, -0.10 to 0.10), ICU admission rate (aOR, 1.20; 95% CI, 0.80-1.79), or proportion of ALC admissions (aOR, 0.98; 95% CI, 0.22 to 4.34). However, they differed significantly for 7-day readmission rates (aOR, 1.25; 95% CI, 1.10 to 1.43) and 30-day readmission rates (aOR, 1.25; 95% CI, 1.10 to 1.42), both higher in academic hospitals than community hospitals. Overall, community and academic hospitals have similar patient demographics and hospital outcomes, however, there was a higher readmission rate at academic hospitals comparatively.  

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