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Patient Outcomes in Teaching Versus Nonteaching General Internal Medicine Services: A Systematic Review and Meta-Analysis

Au, Anita G. MD; Padwal, Raj S. MD, MSc; Majumdar, Sumit R. MD, MPH; McAlister, Finlay A. MD, MSc

doi: 10.1097/ACM.0000000000000154
Reviews

Purpose: Patient care quality appears to be similar when delivered by trainee and attending physicians. The authors conducted a systematic review and meta-analysis to examine whether outcomes differ for general internal medicine (GIM) patients admitted to teaching versus nonteaching services.

Method: The authors searched Medline, EMBASE, and Cochrane Library databases in May 2012 to identify peer-reviewed, English-language studies with contemporaneous controls comparing inpatient mortality, 30-day readmission rate, and/or length of stay (LOS) for inpatients admitted to teaching or nonteaching GIM services.

Results: The 15 included studies (1 randomized controlled trial, 14 observational) included 108,570 patients admitted to U.S. hospitals during 1987–2011. Inpatient mortality did not differ between teaching and nonteaching services (13 studies, 108,015 patients; 2.5% versus 2.8%; OR, 1.07; 95% CI, 0.87–1.32; I2 = 82%); results were consistent in risk-adjusted studies (adjusted OR, 0.91; 95% CI, 0.76–1.08) and higher-quality studies (OR, 0.94; 95% CI, 0.73–1.21). There were no differences in 30-day readmission rates (11 studies, 106,021 patients; 15.1% versus 13.1%; OR, 1.05; 95% CI, 0.93–1.18). Patients on teaching services appeared to have longer LOS (11 studies, 82,352 patients; unadjusted mean difference, 0.40 days; 95% CI, 0.04–0.77 days), but there was substantial heterogeneity (I2 = 95%). Differences disappeared in risk-adjusted studies (mean difference: –0.09 days; 95% CI, –0.24 to 0.06 days) and in higher-quality studies (mean difference: –0.05 days; 95% CI, –0.37 to 0.28 days).

Conclusions: There was no convincing evidence that outcomes differed substantively for patients admitted to teaching or nonteaching GIM services.

Dr. Au is clinical lecturer, Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada.

Dr. Padwal is associate professor of medicine, Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada.

Dr. Majumdar is professor of medicine, Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada.

Dr. McAlister is professor of medicine, Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada.

Funding/Support: R.P., S.R.M., and F.A.M. are supported by an alternate funding plan from the Government of Alberta, Canada. S.R.M. and F.A.M. are also supported by career salary awards from Alberta Innovates–Health Solutions.

Other disclosures: S.R.M. holds the Patient Health Management Chair at the University of Alberta, and F.A.M. holds the University of Alberta Chair in Cardiovascular Outcomes.

Ethical approval: Reported as not applicable.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A186 and http://links.lww.com/ACADMED/A187.

Correspondence should be addressed to Dr. McAlister, 2F1.21 WMC, University of Alberta Hospital, 5-134C Clinical Sciences Building, University of Alberta, 11350 83 Avenue, Edmonton, Alberta, Canada T6G 2G3; telephone: (780) 492-9824; e-mail: Finlay.McAlister@ualberta.ca.

© 2014 by the Association of American Medical Colleges