NYMC Student Theses and Dissertations

Date of Award

4-22-2026

Document Type

Doctoral Dissertation - Restricted (NYMC/Touro only) Access

Degree Name

Doctor of Public Health

Department

Public Health

First Advisor

Adam Block

Second Advisor

Kenneth Knapp

Third Advisor

Jamie Palazzo

Abstract

Background: Patient Safety Indicators (PSIs) are widely used to assess hospital safety and quality, yet the impact of teaching status on PSI rates remains debated. This study investigates whether teaching hospitals differ from non-teaching hospitals in rates of PSI- 90 (composite), PSI-3 (pressure ulcer), PSI-6 (iatrogenic pneumothorax), and PSI-12 (pulmonary embolism/deep vein thrombosis) in the United States. Methods: A retrospective, observational analysis was conducted using CMS PSI data (2021–2023) and RAND hospital characteristics. Multivariate regression models adjusted for hospital size, ownership, staffing ratios (residents), case mix index, and geographic location were employed to examine associations between teaching status and PSI outcomes. Results: Among 4,634 hospitals (1,409 teaching; 3,225 non-teaching), differences in PSI-90 and individual PSI rates between teaching and non-teaching hospitals were minimal and not statistically significant. Teaching status explained less than 2% of the variance in PSI rates across all models. Most variation was attributable to patient complexity, hospital resources, and procedural mix rather than institutional designation. Conclusions: Teaching status is not a significant predictor of patient safety outcomes as measured by PSI-90, PSI-3, PSI-6, or PSI-12. Quality improvement efforts should prioritize evidence-based protocols, robust risk adjustment, and targeted interventions rather than focusing solely on teaching status. These findings support policy frameworks that emphasize actionable strategies and fair comparisons across hospital types.

Keywords

hospital quality, patient safety indicators, teaching hospitals, non-teaching hospitals, quality improvement

Disciplines

Health Services Research | Patient Safety | Public Health | Public Health Education and Promotion

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