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Mortality Among Older Medical Patients at Flagship Hospitals and Their Affiliates.
- Source :
-
JGIM: Journal of General Internal Medicine . May2024, Vol. 39 Issue 6, p902-911. 10p. - Publication Year :
- 2024
-
Abstract
- Background: We define a "flagship hospital" as the largest academic hospital within a hospital referral region and a "flagship system" as a system that contains a flagship hospital and its affiliates. It is not known if patients admitted to an affiliate hospital, and not to its main flagship hospital, have better outcomes than those admitted to a hospital outside the flagship system but within the same hospital referral region. Objective: To compare mortality at flagship hospitals and their affiliates to matched control patients not in the flagship system but within the same hospital referral region. Design: A matched cohort study Participants: The study used hospitalizations for common medical conditions between 2018-2019 among older patients age ≥ 66 years. We analyzed 118,321 matched pairs of Medicare patients admitted with pneumonia (N=57,775), heart failure (N=42,531), or acute myocardial infarction (N=18,015) in 35 flagship hospitals, 124 affiliates, and 793 control hospitals. Main Measures: 30-day (primary) and 90-day (secondary) all-cause mortality. Key Results: 30-day mortality was lower among patients in flagship systems versus control hospitals that are not part of the flagship system but within the same hospital referral region (difference= -0.62%, 95% CI [-0.88%, -0.37%], P<0.001). This difference was smaller in affiliates versus controls (-0.43%, [-0.75%, -0.11%], P=0.008) than in flagship hospitals versus controls (-1.02%, [-1.46%, -0.58%], P<0.001; difference-in-difference -0.59%, [-1.13%, -0.05%], P=0.033). Similar results were found for 90-day mortality. Limitations: The study used claims-based data. Conclusions: In aggregate, within a hospital referral region, patients treated at the flagship hospital, at affiliates of the flagship hospital, and in the flagship system as a whole, all had lower mortality rates than matched controls outside the flagship system. However, the mortality advantage was larger for flagship hospitals than for their affiliates. [ABSTRACT FROM AUTHOR]
- Subjects :
- *OLDER patients
*HOSPITAL patients
*MYOCARDIAL infarction
*MORTALITY
*HEART failure
Subjects
Details
- Language :
- English
- ISSN :
- 08848734
- Volume :
- 39
- Issue :
- 6
- Database :
- Academic Search Index
- Journal :
- JGIM: Journal of General Internal Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 177062810
- Full Text :
- https://doi.org/10.1007/s11606-023-08415-w