Meltzer D, Shah M, Morrison J, Jin L, Levinson W; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2001; 18: 115.
University of Chicago, 5841 S. Maryland MC 2007, Chicago, IL 60637, Phone: (773) 702-0836, Fax: (773) 834-2238, E-mail: dmeltzer@medicine.bsd.uchicago.edu
RESEARCH OBJECTIVE: Hospitalist physicians who specialize in inpatient care are rapidly increasing in number but there is limited evidence from randomized trials concerning their effects on resource utilization and outcomes or how they achieve their effects. This project aims to determine the effect of hospitalists on resource use and outcomes on a general medicine service in an academic medical center and the mechanism for their effects.STUDY DESIGN: A longitudinal trial from July 1997-June 1999 with all patients admitted every fourth day assigned to teams led by hospitalist physicians (HPs) who care for inpatients 6 months per year versus teams led by non-hospitalist physicians (NHPs) who care for inpatients 1 or 2 months per year. Resource utilization was measured by length of stay and costs. Patient outcomes were measured by 30-, 60-, and 365-day mortality rates, readmission rates, reported physical function, and patient satisfaction.POPULATION STUDIED: Patients on a general medicine service in an urban academic teaching hospital.PRINCIPAL FINDINGS: Of 6511 admissions to the general medicine service, 24.8% were to HPs and 75.2% to NHPs. Patients cared for by HPs and NHPs did not differ in age, race, gender, diagnosis mix, Charlson index, or payer mix. Average length of stay for the general medicine service was 4.7 days and average cost was $8517. In multiple regression analysis controlling for diagnosis with DRG weight and for comorbidity with Charlson index, HPs did not have different length of stay or costs than NHPs in year 1, but HPs had 0.5 day lower length of stay (p<0.01) and $740 lower costs (p<0.01) in year 2. There were no differences in mortality in year 1, but in year 2 HPs had lower mortality at 30 days (4.2% vs. 6.0% for NHP, p<0.04), and 60 days (8.8% vs. 6.8%, p<0.07). There were no statistically significant differences between HPs and NHPs in 365-day mortality rate, readmission rate, physical function, or overall patient satisfaction, but the trends favored HPs in all these measures. In analyses controlling for diagnosis-specific fixed effects, month of admission, total volume of patients seen by the physician to date, and total volume of patients with the same diagnosis seen by the physician to date, the effect of hospitalists on length of stay and costs, but not mortality, was explained by diagnosis-specific clinician volume to date.CONCLUSIONS: Over time, HPs decreased length of stay and costs and mortality at 30 and 60 days compared to NHPs. HP's greater disease-specific experience treating patients with common diagnoses partially explains their lower resource use, but does not appear to explain their reductions in mortality. Experience treating patients with a given illness may be an important determinant of resource utilization, even for common conditions. The use of HPs and other approaches that increase physician experience with specific clinical conditions may reduce resource use while maintaining or improving outcomes.IMPLICATIONS FOR POLICY, DELIVERY, OR PRACTICE: HPs and other approaches that increase physician experience with specific clinical conditions should be further studied as promising strategies to improve costs and outcomes.PRIMARY FUNDING SOURCE: National Institute of Aging, University of Chicago Hospitals, Culpeper Foundation, and Aetna Managed Care Forum
Publication Types:
Keywords:
- Academic Medical Centers
- Chicago
- Clinical Trials as Topic
- Diagnosis-Related Groups
- Health Resources
- Hospitalists
- Hospitalization
- Hospitals, Teaching
- Hospitals, Urban
- Humans
- Inpatients
- Managed Care Programs
- Patient Satisfaction
- Physicians
- economics
- hsrmtgs
Other ID:
UI: 102273382
From Meeting Abstracts