O'Connor Alec B, Lang Valerie J, Lurie Stephen J, Lambert David R, Rudmann Andrew, Robbins Brett, Bordley Donald R
Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
Acad Med. 2009 Feb;84(2):220-5. doi: 10.1097/ACM.0b013e3181939718.
Nonteaching services (NTSs) are becoming increasingly prevalent in academic hospitals. This study was designed to determine whether the presence of an NTS is associated with higher acuity and altered case mix on the teaching service.
The authors carried out a retrospective, cross-sectional analysis of data about all general medical admissions between January 1, 2005 and June 30, 2005 to either of two teaching hospitals in Rochester, New York. A total of 6,907 inpatients were studied, of whom 1,976 (29%) were admitted to medicine resident services and 4,931 (71%) were admitted to NTSs. Hospital billing databases were used to determine patient demographics, ICD-9 diagnoses, Charlson Comorbidity Index scores, and patient disposition.
Compared with NTS patients, patients on resident services had higher median Charlson Comorbidity Index scores (3.0 versus 2.0, P < .001) and numbers of comorbidities (9.0 versus 8.0, P < .001) and were more likely to require intensive care (15.5% versus 7.6%, P < .001) and to die in the hospital (8.2% versus 4.5%, P < .001). Patients on the resident services were more likely to have acute renal failure, respiratory failure, septicemia, and HIV. Residents were less likely to care for patients with primary diagnoses of chest pain, cellulitis, alcohol withdrawal, and sickle cell crisis. The differences in patients' conditions between resident services and NTSs were similar in the two hospitals and also among patients who had not received intensive care.
Patients on resident services may be more medically complex and more likely to have high-acuity diagnoses than patients on NTSs. How these differences affect residents' education, residents' career decisions, and practice styles deserves further study.
非教学服务（NTSs）在学术医院中越来越普遍。本研究旨在确定NTSs的存在是否与教学服务中更高的病情严重程度和病例组合变化相关。
作者对2005年1月1日至2005年6月30日期间纽约罗切斯特两家教学医院之一的所有普通内科住院患者的数据进行了回顾性横断面分析。共研究了6907名住院患者，其中1976名（29%）入住内科住院医师服务，4931名（71%）入住NTSs。利用医院计费数据库确定患者人口统计学、ICD-9诊断、查尔森合并症指数评分和患者处置情况。
与NTS患者相比，住院医师服务患者的查尔森合并症指数中位数更高（3.0对2.0，P <.001），合并症数量更多（9.0对8.0，P <.001），更有可能需要重症监护（15.5%对7.6%，P <.001）和在医院死亡（8.2%对4.5%，P <.001）。住院医师服务患者更有可能患有急性肾衰竭、呼吸衰竭、败血症和艾滋病毒。住院医师照顾原发性诊断为胸痛、蜂窝织炎、酒精戒断和镰状细胞危象患者的可能性较小。住院医师服务和NTSs之间患者病情的差异在两家医院以及未接受重症监护的患者中相似。
与NTS患者相比，住院医师服务患者的医疗情况可能更复杂，更有可能有高 acuity诊断。这些差异如何影响住院医师的教育、住院医师的职业决策和实践方式值得进一步研究。
