The Effect of Starting a New Residency Program on the Quality of Care Measures at a Community Hospital: A 2-Year Follow-Up

HCA Healthc J Med. 2021 Jun 28;2(3):223-228. doi: 10.36518/2689-0216.1205. eCollection 2021.


Background: Introducing graduate medical education to a non-teaching hospital has been a challenging issue due to its perceived possible negative impact on quality and cost of care.

Objective: To assess the impact of starting a new Internal Medicine (IM) residency program on the quality of care measures in a Graduate Medical Education (GME) naïve community hospital.

Methods: In a retrospective longitudinal study, we compared quality of care parameters (mortality rate, 30-day readmission rate, length of stay, case mix index and severity level) for a hospitalist group ten months before (September 2015-June 2016) and two consecutive years (July 2016-June 2018) after the implementation of an IM residency program at a community hospital.

Results: We compared the aggregated data from 1,295 patients before starting the residency program to 2,532 and 3,061 patients, in two consecutive academic years after initiating an IM residency. For the hospitalist group that became the teaching group, the mortality rate decreased significantly from 10 months pre- and the two post-residency periods (2%, 1% and 0.2%, p-value < 0.01), while the mortality rate among non-teaching hospitalist group patients at the same hospital remained unchanged over the same time period (p = 0.70). Length of stay decreased significantly from 10-months pre-residency to 1-year post-residency (6.23 and 5.31, p-value = 0.01). Furthermore, there were no other significant differences between the groups in terms of 30-day readmission rate, complications in care and average cost per case.

Conclusions: Starting a new residency program in a non-teaching hospital improves mortality rate without significantly affecting other quality measures.

Keywords: 30-day readmission; graduate medical education; hospital mortality; length of stay; mortality rate; quality of care; teaching hospitals.

Grants and funding

This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity.