Journal of General Internal Medicine

, 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?

  • Vikas Parekh
  • Sanjay Saint
  • Scott Furney
  • Samuel Kaufman
  • Laurence McMahon
Original Articles

DOI: 10.1111/j.1525-1497.2004.30298.x

Cite this article as:
Parekh, V., Saint, S., Furney, S. et al. J GEN INTERN MED (2004) 19: 395. doi:10.1111/j.1525-1497.2004.30298.x

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.

Key words

hospitalistsubspecialistlength of stayoutcomescost

Copyright information

© Society of General Internal Medicine 2004

Authors and Affiliations

  • Vikas Parekh
    • 1
  • Sanjay Saint
    • 1
    • 2
    • 3
  • Scott Furney
    • 4
  • Samuel Kaufman
    • 3
  • Laurence McMahon
    • 1
    • 5
  1. 1.the Department of Internal MedicineUniversity of Michigan Health SystemUSA
  2. 2.Health Services Research and Development Center of ExcellenceAnn Arbor Veterans Affairs Medical CenterUSA
  3. 3.Patient Safety Enhancement ProgramUniversity of Michigan Health SystemAnn Arbor
  4. 4.Department of Internal MedicineCarolinas Medical CenterCharlotte
  5. 5.the Department of Health Management and PolicySchool of Public Health, University of MichiganAnn Arbor
  6. 6.3116 Taubman CenterUniversity of Michigan Health SystemAnn Arbor