Do patients in teaching hospitals get better care?

Hospitals where doctors receive training are generally thought of as the most advanced type of hospital. So, for the patient, is it best to be admitted to a 'teaching hospital'? A review of the evidence from international research has concluded that there is no strong evidence that patients in teaching hospitals do better –or worse - than those admitted to other hospitals.

Some people have argued that teaching hospitals ought to provide the best care, as they usually have the best equipment and the most highly qualified staff. However, it has also been claimed that, as people in training are involved in providing some of the treatment, patients may face greater risks. Researchers at the University of Ioannina School of Medicine in Greece set out to settle the question. The results of their research are published in PLoS Medicine.

This is a difficulty issue to study. Because of the high reputation of teaching hospitals, the patients whose condition is the most serious are often sent there, with other patients going to nonteaching hospitals. Obviously, it would not be a fair test to compare the most seriously ill patients with those whose condition was less serious.

The University of Ioannina team did not do any new work involving patients. Instead they conducted a thorough search internationally for studies that had already been done, which met criteria that they had specified in advance. This type of research is called a "systematic review". They found 132 studies that had compared the outcomes of patients in teaching or nonteaching hospitals. They were all "observational studies" where researchers had gathered information on what was already taking place, rather than setting up an experiment. In 14 studies, allowances had been made for differences in such factors as the severity of the patients' condition, and whether or not they had more than one type of illness when they were treated. There was a great deal of variability in the results between these studies but, overall, no clear difference was found in the effectiveness of treatment provided by the two types of hospital.

There is no evidence that it is better (or worse) to be given treatment in a teaching or a nonteaching hospital. The researchers note that a limitation of their analysis is that it was based on studies that were not "randomized controlled trials". (The most reliable way of comparing two types of treatment is to decide at random which treatment each patient receives but, in practice, it would be difficult to set up a study where the decision on which hospital a patient should go to was made at random.)

The researchers also raise the possibility that differences might be found if considering specific diseases one by one, rather than putting information on all conditions together. However, they believe that any such difference would be small. Their findings will be useful in the continuing debate on the most effective ways to train doctors, while at the same time providing the best possible care for patients.

Citation: Papanikolaou PN, Christidi GD, Ioannidis JPA (2006) Patient outcomes with teaching versus nonteaching healthcare: a systematic review. PLoS Med 3(9): e341.

PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://dx.doi.org/10.1371/journal.pmed.0030341

PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-03-09-ioannidis.pdf

CONTACT:
John Ioannidis
University of Ioannina School of Medicine
Department of Hygiene and Epidemiology
University Campus
Ioannina, Epirus 45110 Greece
302651097807
302651097867 (fax)
jioannid@cc.uoi.gr

Citation: Clark J, Tugwell P (2006) Does academic medicine matter? PLoS Med 3(9): e340.

PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://dx.doi.org/10.1371/journal.pmed.0030340

PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-03-09-clark.pdf

CONTACT:
Jocalyn Clark
International Campaign to Revitalise Academic Medicine (ICRAM)
Associate Editor, British Medical Journal
United States of America
416-964-7411
jclark@bmj.com

PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. For more information, visit http://www.plosmedicine.org

The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource. For more information, visit http://www.plos.org

All works published in PLoS Medicine are open access. Everything is immediately available without cost to anyone, anywhere--to read, download, redistribute, include in databases, and otherwise use--subject only to the condition that the original authorship is properly attributed. Copyright is retained by the authors. The Public Library of Science uses the Creative Commons Attribution License.