Extensive debate exists in the healthcare community over whether outcomes of medical care at teaching hospitals and other healthcare units are better or worse than those at the respective nonteaching ones. Thus, our goal was to systematically evaluate the evidence pertaining to this question.
We reviewed all studies that compared teaching versus nonteaching healthcare structures for
mortality or any other patient outcome, regardless of health condition. Studies were retrieved from PubMed, contact with experts, and literature cross-referencing. Data were extracted on setting, patients, data sources, author affiliations, definition of compared groups, types of diagnoses considered, adjusting covariates, and estimates of effect for mortality and for each other outcome. Overall, 132 eligible studies were identified, including 93 on mortality and 61 on other eligible outcomes (22 addressed both). Synthesis of the available adjusted estimates on mortality yielded a summary relative risk of 0.96 (95% confidence interval [CI], 0.93–1.00) for teaching versus nonteaching healthcare structures and 1.04 (95% CI, 0.99–1.10) for minor teaching versus nonteaching ones. There was considerable heterogeneity between studies (I2 = 72% for the main analysis). Results were similar in studies using clinical and those using administrative databases. No differences were seen in the 14 studies fully adjusting for volume/experience, severity, andcomorbidity (relative risk 1.01). Smaller studies did not differ in their results from larger studies. Differences were seen for some diagnoses (e.g., significantly better survival for breast cancer and cerebrovascular accidents in teaching hospitals and significantly better survival from cholecystectomy in nonteaching hospitals), but these were small in magnitude. Other outcomes were diverse, but typically teaching healthcare structures did not do better than nonteaching ones.
The available data are limited by their nonrandomized design, but overall they do not suggest that a healthcare facility's teaching status on its own markedly improves or worsens patient outcomes. Differences for specific diseases cannot be excluded, but are likely to be small.
Funding: The authors received no specific funding for this study.
Competing Interests: The authors have declared that no competing interests exist.
Academic Editor: Andrew D. Oxman, Norwegian Directorate for Health and Social Welfare, Norway
Citation: Papanikolaou PN, Christidi GD, Ioannidis JPA (2006) Patient Outcomes with Teaching Versus Nonteaching Healthcare: A Systematic Review. PLoS Med 3(9): e341 DOI: 10.1371/journal.pmed.0030341
Received: February 7, 2006; Accepted: June 9, 2006; Published: September 12, 2006
Copyright: © 2006 Papanikolaou et al.
Abbreviations: CI, confidence interval; RR, relative risk
