Patient Outcomes with Teaching Versus Nonteaching Healthcare A Systematic Review 英文参考文献.docVIP

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Patient Outcomes with Teaching Versus Nonteaching Healthcare A Systematic Review 英文参考文献.doc

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Patient Outcomes with Teaching Versus Nonteaching Healthcare A Systematic Review 英文参考文献

o PL SMEDICINE PatientOutcomeswithTeaching VersusNonteachingHealthcare: ASystematicReview Panagiotis N.Papanikolaou1,Georgia D.Christidi1,John P.A.Ioannidis1,2* 1 Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece, 2 Institute for Clinical Research and Health Policy Studies, DepartmentofMedicine,TuftsUniversitySchoolofMedicine,Boston,Massachusetts,UnitedStatesofAmerica Funding:Theauthorsreceivedno specificfundingforthisstudy. ABSTRACT CompetingInterests:Theauthors havedeclaredthatnocompeting interestsexist. Background Extensivedebateexistsinthehealthcarecommunityoverwhetheroutcomesofmedicalcare at teaching hospitals and other healthcare units are better or worse than those at the respective nonteaching ones. Thus, our goal was to systematically evaluate the evidence pertainingtothisquestion. AcademicEditor:AndrewD. Oxman,NorwegianDirectoratefor HealthandSocialWelfare,Norway Citation:PapanikolaouPN,Christidi GD,IoannidisJPA(2006)Patient outcomeswithteachingversus nonteachinghealthcare:a MethodsandFindings systematicreview.PLoSMed3(9): e341.DOI:10.1371/journal.pmed. 0030341 Wereviewedallstudiesthatcomparedteachingversusnonteachinghealthcarestructuresfor mortalityoranyotherpatientoutcome,regardlessofhealthcondition.Studieswereretrieved from PubMed, contact with experts, and literature cross-referencing. Datawere extracted on setting, patients, data sources, author affiliations, definition of compared groups, types of diagnosesconsidered,adjustingcovariates,andestimatesofeffectformortalityandforeach otheroutcome.Overall,132eligiblestudieswereidentified,including93onmortalityand61 onothereligibleoutcomes(22addressedboth).Synthesisoftheavailableadjustedestimates onmortalityyieldedasummaryrelativeriskof0.96(95%confidenceinterval[CI],0.93–1.00)for teaching versus nonteaching healthcare structures and 1.04 (95% CI, 0.99–1.10) for minor teachingversusnonteachingones.Therewasconsiderableheterogeneitybetweenstudies(I2? 72% fo