Characteristics of Syncope Admissions Among Hospitals of Varying Teaching Intensity.

Abstract

Previous work suggests that hospitals' teaching status is correlated with readmission rates, cost of care, and mortality. The degree to which teaching status is associated with the management of syncope has not been studied extensively. We sought to characterize the relation between teaching status and inpatient syncope management. We created regression models to characterize the relation between teaching status and cardiac ischemic evaluations (cardiac catheterization and/or stress test) during syncope admissions. Admissions with a primary diagnosis of syncope in Maryland and Kentucky between 2007 and 2014 were included. The dataset included 71,341 syncope admissions at 151 hospitals. Overall, 15% of patients had an ischemic evaluation. There was a significantly lower likelihood of an ischemic evaluation at major teaching hospitals relative to nonteaching hospitals (adjusted odds ratio 0.75, 95% confidence interval 0.71-0.79), but a higher likelihood of an ischemic evaluation at minor teaching hospitals (adjusted odds ratio 1.21, 95% confidence interval 1.16-1.25). By definition, the syncope admissions included were unexplained or idiopathic cases, and thus likely to be lower-risk syncope cases. Those with a known etiology are coded by the cause of syncope, as dictated by coding guidelines. It is likely that many of these ischemic evaluations represent low-value care. Financial incentives and processes of care at major teaching hospitals may be driving this trend, and efforts should be made to better understand and replicate these at minor teaching and nonteaching hospitals.