Dr. Au is clinical lecturer, Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada. Dr. Padwal is associate professor of medicine, Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada. Dr. Majumdar is professor of medicine, Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada. Dr. McAlister is professor of medicine, Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada.
Acad Med. 2014 Mar;89(3):517-23. doi: 10.1097/ACM.0000000000000154.
Patient care quality appears to be similar when delivered by trainee and attending physicians. The authors conducted a systematic review and meta-analysis to examine whether outcomes differ for general internal medicine (GIM) patients admitted to teaching versus nonteaching services.
The authors searched Medline, EMBASE, and Cochrane Library databases in May 2012 to identify peer-reviewed, English-language studies with contemporaneous controls comparing inpatient mortality, 30-day readmission rate, and/or length of stay (LOS) for inpatients admitted to teaching or nonteaching GIM services.
The 15 included studies (1 randomized controlled trial, 14 observational) included 108,570 patients admitted to U.S. hospitals during 1987-2011. Inpatient mortality did not differ between teaching and nonteaching services (13 studies, 108,015 patients; 2.5% versus 2.8%; OR, 1.07; 95% CI, 0.87-1.32; I = 82%); results were consistent in risk-adjusted studies (adjusted OR, 0.91; 95% CI, 0.76-1.08) and higher-quality studies (OR, 0.94; 95% CI, 0.73-1.21). There were no differences in 30-day readmission rates (11 studies, 106,021 patients; 15.1% versus 13.1%; OR, 1.05; 95% CI, 0.93-1.18). Patients on teaching services appeared to have longer LOS (11 studies, 82,352 patients; unadjusted mean difference, 0.40 days; 95% CI, 0.04-0.77 days), but there was substantial heterogeneity (I = 95%). Differences disappeared in risk-adjusted studies (mean difference: -0.09 days; 95% CI, -0.24 to 0.06 days) and in higher-quality studies (mean difference: -0.05 days; 95% CI, -0.37 to 0.28 days).
There was no convincing evidence that outcomes differed substantively for patients admitted to teaching or nonteaching GIM services.
在接受受训医师和主治医生的治疗时，患者的护理质量似乎相似。作者进行了系统回顾和荟萃分析，以检验接受教学服务和非教学服务的普通内科（GIM）住院患者的结果是否存在差异。
作者于 2012 年 5 月在 Medline、EMBASE 和 Cochrane Library 数据库中搜索了同行评审的英文文献，以确定具有同期对照的研究，比较了教学和非教学 GIM 服务住院患者的住院死亡率、30 天再入院率和/或住院时间（LOS）。
15 项纳入的研究（1 项随机对照试验，14 项观察性研究）包括 1987 年至 2011 年期间在美国医院住院的 108570 名患者。教学服务和非教学服务之间的住院死亡率没有差异（13 项研究，108015 名患者；2.5%与 2.8%；OR，1.07；95%CI，0.87-1.32；I = 82%）；在风险调整研究中结果一致（调整后的 OR，0.91；95%CI，0.76-1.08）和高质量研究中结果一致（OR，0.94；95%CI，0.73-1.21）。30 天再入院率无差异（11 项研究，106021 名患者；15.1%与 13.1%；OR，1.05；95%CI，0.93-1.18）。接受教学服务的患者的 LOS 似乎更长（11 项研究，82352 名患者；未调整的平均差异，0.40 天；95%CI，0.04-0.77 天），但存在很大的异质性（I = 95%）。在风险调整研究中，差异消失（平均差异：-0.09 天；95%CI，-0.24 至 0.06 天）和在高质量研究中差异消失（平均差异：-0.05 天；95%CI，-0.37 至 0.28 天）。
没有令人信服的证据表明接受教学服务和非教学服务的 GIM 住院患者的结果存在实质性差异。
