Abstract
This paper assesses whether there is a significant difference in socioeconomic condition (income), insurance status, and Length of Stay (LOS) of inpatients diagnosed with diabetic myocardial infarction in teaching vs nonteaching hospitals. A retrospective data analysis of discharges was conducted from the 2008 Healthcare Cost and Utilization Project, Nationwide Inpatient Sample. Sample selection was based on the International Classification of Diseases, Ninth Revision, codes with LOS as the outcome variable. Teaching hospitals have longer LOS compared to nonteaching hospitals for patients with incomes below $48,000 (χ2=16.185, df=6, P < 0.013). The duration of hospital LOS is higher in teaching than in nonteaching hospitals for patient insurance (χ2=24.975, df=6, P=0.0001). For patients with Medicare, the hospital stay of 1 day and less is lower in nonteaching hospitals. Teaching hospitals have higher rates of LOS than nonteaching hospitals for the age group, 65-74 (χ2=37.294, df=6, P=0.0001). Especially for hospital stays of more than 6 days, the LOS is higher in teaching hospitals. The difference in LOS in teaching and nonteaching hospitals is statistically significant for males (P=0.009) vs. females (P=0.003). The results of this study indicate that the difference in LOS between teaching and nonteaching hospitals based on patient age, income, and insurance is statistically significant. When one controls for the independent variables in this study, the difference presented is large enough to affect clinical policy. These findings highlight the need for interventions to increase awareness of health care disparities that exist among inpatients with diabetic myocardial infarction, especially for low-income and older patients who do not qualify for Medicare.
Highlights
Coronary artery disease is the leading cause of premature, permanent disability in the United States, accounting for about 20% of disability allowances by the Social Security Administration (AHA) [1]
Nonteaching hospitals serve higher proportion of whites than do teaching hospitals these patients may be transferred or die before discharge from teaching hospitals; other ethnic groups stay for a shorter period than the white population, with the biggest inequality among low-income patients and shorter Length of Stay (LOS) in nonteaching hospitals (Table 1)
A patient under 65 years of age was higher for teaching hospitals than for nonteaching hospitals; on the other hand the percentage of patients 75 years or older was higher for nonteaching hospitals than for teaching hospitals
Summary
Coronary artery disease is the leading cause of premature, permanent disability in the United States, accounting for about 20% of disability allowances by the Social Security Administration (AHA) [1]. According to the 2008 National Healthcare Disparity Report, mortality from myocardial infarction (MI) in 2005 was 652,091, ranking first while diabetes ranked sixth with a mortality rate of 75,119 and total cost of $174 billion with $116 billion in direct medical cost. The total cost for cardiovascular diseases in 2008 was $448.5 billion with a direct medical cost of $296.4 billion [2]. Few studies have reported more mortality rates in teaching hospitals and the outcomes in minor teaching hospitals. Polanczyk et al [5] and Dowell et al [6] concluded that whether the outcomes observed in minor teaching hospitals were due to hospital characteristics, quality, or process of care factors still needs to undergo further investigation
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