What effect does inpatient physician specialty and experience have on clinical outcomes and resource utilization on a general medical service?
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OBJECTIVE: To examine the effects of internal medicine specialty and physician experience on inpatient resource use and clinical outcomes on an academic general medicine service.
DESIGN: A 1-year retrospective cohort study.
SETTING: The University of Michigan Hospitals, Ann Arbor, Michigan.
PATIENTS: Two thousand six hundred seventeen admissions to the general medicine service from July 2001 to June 2002, excluding those for whom data were incomplete (n=18).
MEASUREMENTS AND MAIN RESULTS: Length of stay (LOS) and total hospital costs were used to measure resource utilization. Hospital mortality and 14-day and 30-day readmission rates were used to measure clinical outcomes. Adjusted mean LOS was significantly greater for rheumatologists (0.56 days greater; P=.002) and endocrinologists (0.38 days greater; P=.03) compared to general internists. Total costs were lower for general internists compared to endocrinologists ($1100 lower; P=.01) and rheumatologists ($431 lower; P=.07). Hospitalists showed a trend toward reduced LOS compared to all other physicians (0.31 days lower; P=.06). The top two deciles of physicians stratified by recent inpatient general medical experience showed significantly reduced LOS compared to all other physicians (0.35 days lower; P=.04). No significant differences were seen in readmission rates or in-hospital mortality among the various physician groups.
CONCLUSIONS: General internists had lower lengths of stay and costs compared to endocrinologists and rheumatologists. Hospitalists showed a trend toward reduced LOS compared to all other physicians. Recent inpatient general medicine experience appears to be a determinant of reduced inpatient resource use.
- Lurie J, Miller D, Lucknaw P, Wachter R, Sox H. The potential size of the hospitalist workforce in the United States. Am J Med. 1999;106:441–5. CrossRef
- Wachter R. An introduction to the hospitalist model. Ann Intern Med. 1999;130:338–42.
- Wachter R, Goldman L. The hospitalist movement 5 years later. JAMA. 2002;287:487–94. CrossRef
- Wachter R, Katz P, Showstack J, Bindman A, Goldman L. Reorganizing an academic medical service: impact on cost, quality, patient satisfaction and education. JAMA. 1998;279:1560–5. CrossRef
- Diamond HS, Goldberg E, Janoskly JE. The effect of full time faculty hospitalists on efficiency of care at a community teaching hospital. Ann Intern Med. 1998;129:197–203.
- Kearns P, Way C, Morris W, et al. Hospital care by hospital-based and clinic-based faculty: a prospective controlled trial. Arch Intern Med. 2001;161:235–41. CrossRef
- Auerbach A, Wachter R, Katz P, Showstack J, Baron R, Goldman L. Implementation of a voluntary hospitalists service at a community teaching hospital: improved clinical efficiency and patient outcomes. Ann Intern Med. 2002;137:859–65.
- Meltzer D, Manny W, Morrison J, et al. Effects of physician experience on costs and outcomes on an academic general medicine service: results of a trial of hospitalists. Ann Intern Med. 2002;137:866–74.
- Palmer H, Armistead N, Marivannan S, et al. The effect of a hospitalist service on patient care in an academic teaching hospital. J Gen Intern Med. 1999;14(suppl):S116.
- Palmer H, Delamatta M, Mebride C, et al. After discharge effects of a hospitalist service. J Gen Intern Med. 2001;16(suppl):S211.
- Palmer H, Armistead N, Elnicki M, et al. The effect of a hospitalist service with nurse discharge planner on patient care in an academic teaching hospital. Am J Med. 2001;111:627–32. CrossRef
- Bernard A, Shapiro L, McMahon L. The influence of attending physician subspecialization on hospital length of stay. Med Care. 1990;28:170–4. CrossRef
- Hayward R, Manning G, McMahon L, Bernard A. Do attending or resident physician practice styles account for variations in hospital resource use? Med Care. 1994;32:788–94. CrossRef
- The Editors of the Annals of Internal Medicine. The who, what, where, whom, and how of hospitalist care. Ann Intern Med. 2002;137:930–1.
- What effect does inpatient physician specialty and experience have on clinical outcomes and resource utilization on a general medical service?
Journal of General Internal Medicine
Volume 19, Issue 5 , pp 395-401
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- length of stay
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- Author Affiliations
- 1. the Department of Internal Medicine, University of Michigan Health System, USA
- 3. Health Services Research and Development Center of Excellence, Ann Arbor Veterans Affairs Medical Center, USA
- 4. Patient Safety Enhancement Program, University of Michigan Health System, Ann Arbor, Mich
- 5. Department of Internal Medicine, Carolinas Medical Center, Charlotte, NC
- 6. the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Mich