Comparison of hospitalists and nonhospitalists in inpatient length of stay adjusting for patient and physician characteristics

Abstract

OBJECTIVE:To determine the independent effect of hospitalist status upon inpatient length of stay after controlling for case mix, as well as patient-level and provider-level variables such as age, years since physician medical school graduation, and volume status of provider. DESIGN:Observational retrospective cohort study employing a hierarchical random intercept logistic regression model. SETTING:Tertiary-care teaching hospital. PATIENTS:All admissions during 2001 to the department of medicine not sent initially to the medical intensive care unit or coronary care unit. MEASUREMENTS:Observed length of stay (LOS) compared to principle diagnosis related group (DRG)-specific mean LOS for hospitalist and nonhospitalist patients adjusting for patient age, gender, years since physician graduation from medical school, and physician volume status. MAIN RESULTS:The 9 hospitalists discharged 2,027 patients while the nonhospitalists discharged 9,361 patients. On average, hospitalist patients were younger, 63.3 versus 73.3 years ( P < .0001). Hospitalists were more recently graduated from medical school, 13.8 versus 22.5 years ( P = .02). Each year of patient age was found to increase the likelihood of an above average LOS (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.01 to 1.02; P < .001). In unadjusted analysis, hospitalists were less likely to have an above average LOS (OR, 0.51; 95% CI, 0.28 to 0.93; P = .03). Adjustment for effects of patient age and gender, physician gender, years since medical school graduation, and quintile of physician admission volume did not appreciably change the point estimate that hospitalist patients remained less likely to have above average LOS (OR, 0.60; 95% CI, 0.32 to 1.11; P = .11). CONCLUSIONS:For a given principle DRG, hospitalist patients were less likely to exceed the average LOS than were nonhospitalist patients. This effect was rather large, in that hospitalist status reduced the likelihood of above average LOS by about 49%. Adjustment for patient age, years since physician graduation, and admission volume did not significantly alter this finding. Further research should focus on identifying specific practices that account for hospitalism's effects.KEY WORDS: hospitalist; length of stay; patient-level variables; provider-level variables; provider volume.

Patient satisfaction with hospital care provided by hospitalists and primary care physicians

“…1 Studies demonstrate that, compared to a system where primary care physicians provide inpatient care, the hospitalist model improves efficiency while maintaining at least equal patient outcomes. [2][3][4][5][6][7][8][9][10][11] However, scant data exist as to the effects of hospitalists on patient satisfaction. 12 Understanding how care models affect patient experience is vital in the current environment of healthcare reform and performance reporting, especially in light of the Centers for Medicare and Medicaid Services' (CMS) efforts to link the patient experience to reimbursement through ''value-based'' purchasing.…”

Fulfilling the Promise of Hospital Medicine: Tailoring Internal Medicine Training to Address Hospitalists’ Needs

“…Of the seven publications from academic hospitalist groups that included substantial case mix information, three described only a single neurologic diagnosis, and none listed an orthopedic condition in their 15 most common diagnoses. 8,12,13,[30][31][32][33] Only one of the programs that recorded a neurologic diagnosis was based at a university hospital. 32 In comparison, our study showed that orthopedic (hip fracture) and neurologic diagnoses (syncope, acute stroke, seizure and transient ischemic attack) comprised a third of the top 15 diagnoses that hospitalists manage.…”

Defining the Role of the Academic Neurohospitalist in Residency Education

“…13,14 This early experience is similar to that of medicine hospitalists who have been shown to increase value by lowering the cost of care while maintaining its quality. [15][16][17][18] In addition, medicine hospitalists have exceeded expectations in translating this experience into improved education of trainees. [19][20][21][22] Availability of neurohospitalists to residents without the added pressures of outpatient clinics or research laboratories is expected to enhance direct resident supervision and improve patient care.…”