, Volume 19, Issue 5, pp 395-401

What effect does inpatient physician specialty and experience have on clinical outcomes and resource utilization on a general medical service?

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Abstract

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.

Portions of this study were initially presented at the meetings of the Society of Hospital Medicine, San Diego, Calif, April 1–2, 2003 and the Society of General Internal Medicine, Vancouver, Canada, May 3, 2003.
Dr. Saint is supported by a Career Development Award from the Health Services Research and Development Program of the Department of Veterans Affairs and a Patient Safety Developmental Center Grant from the Agency for Healthcare Research and Quality (P20-HS11540).