Patients, Outcomes Similar at Academic, Community Hospitals

Patient demographics and outcomes are similar at academic and community hospitals in Ontario, new research indicates.

A retrospective cohort study included all adult general medicine patients admitted to or discharged from 28 hospitals in Ontario, Canada, between April 2015 and December 2021. 

Researchers compared demographic and clinical characteristics (including age, sex, acute physiology scores, discharge diagnosis, comorbidity status, frailty risk, and disability and social factors) for patients at academic and community hospitals. They also compared clinical outcomes and processes, such as patient volume per physician, in-hospital mortality, length of stay, readmissions, and intensive care unit (ICU) admissions.

Of 947,070 admissions (609,696 at 17 community hospitals and 337,374 at 11 academic hospitals), demographic and social characteristics, including income, education, and neighborhood racial/ethnic mix were similar between hospital types. Also similar was the number of unique discharge diagnoses.

The findings were published January 15 in JAMA Network Open. 

Two Differences

In an interview with Medscape Medical News, author Michael Colacci, MD, of Li Ka Shing Knowledge Institute at St. Michael’s Hospital in Toronto, Ontario, pointed to two slight differences between the groups. Patient volumes per attending physician were higher at academic hospitals (median daily census, 20 vs 17), and readmissions were higher at academic hospitals. For 7-day readmissions, the academic hospitals’ increased readmissions risk translated to an adjusted odds ratio (aOR) of 1.25. For 30-day readmissions, the aOR was 1.25. After multivariable regression to adjust for baseline factors, mortality, ICU admission rate, and length of stay were not significantly different.

“Most of the findings are generally good news,” Colacci said. “One of the most reassuring findings from this study is that from the standpoint of medical education, having a lot of the training experience at an academic hospital would give you a well-rounded exposure to the types of patients you would later encounter if you worked at a community hospital.”

Reassuring News

That finding was particularly welcome for Rodrigo Cavalcanti, MD, program director of the internal medicine residency program at the University of Toronto. 

Cavalcanti was glad to see the largely similar results because academic hospitals are sometimes thought to treat more complex patients and more disenfranchised patients. The researchers “didn’t see that, which was interesting,” he said.

Cavalcanti added that these new data are reassuring for programs like his because they indicate that residents will be adequately prepared for all work settings.

The data on readmissions also were reassuring, though they were slightly higher at academic hospitals, said Cavalcanti. Concerns about some academic center outcomes arise because of the number of trainees working alongside each staff physician, “but the differences are small enough that they are reassuring to me,” he said.

The results might differ in other provinces because there’s no universal definition of community hospitals, and some provinces may have a much different mix of the two types, Cavalcanti said. But hospital services are universally insured in Canada, which enhances the findings’ generalizability.

Internal Medicine Outcomes

A strength of the study is that it uses an internal medicine lens, where patients have a broad range of diagnoses, unlike in surgical or specialty care, where patients are typically entering the hospital for a specific reason, said Colacci. Few studies have evaluated the types and characteristics of internal medicine patients and their hospital outcomes, he said.

This kind of research could provide information not only on whether residents are being adequately trained, but also on whether the right resources are being allocated to the various hospital types, said Colacci. “If the study had shown big differences in the kinds of patients treated, it might suggest that a realignment of resources would be necessary.”

The biggest message in the data is that “patients treated within general medicine at academic and community hospitals are more similar than they are different,” said Colacci. “Additionally, there’s more variation between community hospitals or between academic hospitals than there is between academic and community hospitals as a whole.”

Though the study was conducted in Ontario, the findings would likely be similar in other provinces with universal healthcare coverage in Canada, though the size of hospitals and geographies may alter the results, he added. “I don’t know that we’d find the same results in a US setting,” he said.

The data platform that the investigators examined was supported by the Canadian Cancer Society, the Canadian Frailty Network, the Canadian Institutes of Health Research, the Canadian Medical Protective Association, Green Shield Canada Foundation, the Natural Sciences and Engineering Research Council of Canada, Ontario Health, St Michael’s Hospital Association Innovation Fund, and the Department of Medicine at the University of Toronto, with in-kind support from partner hospitals and the Vector Institute. Colacci and Cavalcanti reported having no relevant financial relationships.

Marcia Frellick is an independent healthcare journalist based in Chicago.