Before even getting into a 'scholarly' debate over this research, I would have to ask additional questions re: their findings:
Were the academic institutions also state supported? Such institutions are required to accept all patients, including those without insurance, which a large metropolitan hospital and a small private hospital will not accept. This normally means those patients arrive at the hospital sicker, disease status further along, etc.
Were the academic institutions also designated as Level 1 Trauma sites? Patients who are in the worst accidents, have the most terrible injuries imaginable, are diverted to these facilities, adding to morbidity rates.
Were the academic institutions also designated as Comprehensive Cancer Centers? Obviously, many cancer patients choose these facilities, or are sent when all else fails, to these facilities.
The reason academic institutions may have higher morbidity rates, and I don't believe they all do, is because the newest treatment, the latest expertise, and, yes, the latest in research, is being done in the academic institutions. And, yes, your progress is followed by medical students, interns, and residents as well as an attending. But consider this - I much prefer several persons reviewing my chart and progress 24 hours a day to one individual glancing through it only in the AM, to return the next AM. Where else can you get 24 hour care and immediate response to medical change by a qualified medical practitioner?
> the initial findings showed significant differences in
morbidity rates between hospitals associated with academic institutions
(the worst) versus large metropolitan hospitals versus smaller private
hospitals. The study conjectured that the academically inclined
practitioners seemed more concerned with their research than with the
ultimate wellbeing of their patients.
I will side with the academics on this one, by conjecturing that smaller
privates only take rich, less sick patients, leaving the poor and sickest
patients to be treated by residents. Thus the privates could be viewed as
"caring" more for money than "the
ultimate wellbeing of" the people living in their community. Besides no good
researcher wants her subjects dying on her before the study is complete.
Moral: MATCH INPUTS when comparing outputs and also examine the selection bias.
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Prof. John L. Naman naman+@pitt.edu