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?

Authors

    • the Department of Internal MedicineUniversity of Michigan Health System
  • Sanjay Saint
    • the Department of Internal MedicineUniversity of Michigan Health System
    • Health Services Research and Development Center of ExcellenceAnn Arbor Veterans Affairs Medical Center
    • Patient Safety Enhancement ProgramUniversity of Michigan Health System
  • Scott Furney
    • Department of Internal MedicineCarolinas Medical Center
  • Samuel Kaufman
    • Patient Safety Enhancement ProgramUniversity of Michigan Health System
  • Laurence McMahon
    • the Department of Internal MedicineUniversity of Michigan Health System
    • the Department of Health Management and PolicySchool of Public Health, University of Michigan
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
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Copyright information

© Society of General Internal Medicine 2004