Wednesday, September 28, 2005

So Much for the Teaching Hospital Mystique

Most of us have been brought up to believe that the best medical care was provided in teaching hospitals. Even US News and World Report and others who undertook to identify the “best US hospitals” believed it and gave credit for membership in the national Council of Teaching Hospitals and for having large residency programs.

Having spent my entire career in teaching hospitals, I was always a little skeptical about all that. I knew that the most advanced medical procedures and treatments usually appeared first in teaching hospitals (where the research that led to them was done) but was not so sure that the more routine cases that occupied most of the beds were always getting such good care. When measuring outcomes started, I predicted that there would be some surprises.

Well, perhaps I was right. The September 22, 2005 issue of the Boston Globe reported that the UMass Memorial Medical Center in Worcester – teaching hospital for the University of Massachusetts Medical School - had closed down its open heart surgery program because of a mortality rate that was twice the average of Massachusetts hospitals. The absolute numbers were 38 deaths out of 917 operations. Reportedly, the Medical Center had been aware of the problem for at least two years, but decided to shut the program down only after being presented with an analysis of the numbers by the Massachusetts Department of Health.

Asked about the delay, Paul Dryer, director of the Department’s Division of Health Care Quality pointed out that it takes time for a state agency to develop such data and suggested that hospitals ought to be the first to know there is a problem and to take some responsibility for dealing with it. Sounds reasonable to me.

So perhaps the reputation enjoyed by teaching hospitals was partly mystique that the UMass example will help to dispel.

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