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.
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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