Efficiency of the Japanese Hospitalist System for Patients with Urinary Tract Infection: A Propensity-matched Analysis

Abstract

Objective The hospitalist system in the United States has been considered successful in terms of the quality of care and cost effectiveness. In Japan, however, its efficacy has not yet been extensively examined. This study examined the impact of the hospitalist system on the quality of care and healthcare economics in a Japanese population using treatment of urinary tract infection as an example. Methods We analyzed 271 patients whose most resource-consuming diagnosis at admission was urinary tract infection between April 2017 and March 2019. Propensity-matched analyses were performed to compare health care economics and the quality of care between the hospitalist system and the conventional system. Results In matched pairs, care by the hospitalist system was associated with a significantly shorter length of stay than that by the conventional system. The quality of care (oral antibiotics switch rate, rate of appropriate antibiotics change based on urine or blood culture results, detection rate of urinary tract infection etiology and the number of laboratory tests) was also considered to be favorably impacted by the hospitalist system. Although not statistically significant, hospital costs tended to be lower with the hospitalist system than with the conventional system. The mortality rate and 30-day readmission were also not significantly different between the groups. Conclusion The hospitalist system had a favorable impact on the quality of care and length of stay without increasing readmission in patients with urinary tract infection. This study is further evidence of the strong potential for the positive impact of an implemented hospitalist system in Japan.

How Do We Establish the Utility and Evidence of General Medicine in Japan?

“… 14 The evidence supporting the clinical benefits of GM is currently limited, with most evidence regarding cost reduction and improvement in quality of care derived from small-scale, single-center studies. 15 , 16 These studies cover a range of clinical areas, including improved quality of inpatient care for infectious endocarditis, 17 increased blood culture collection rate, 18 shortened length of hospital stay, 19 improved quality of home medical care, 20 COVID-19 care, 21 compensating for the shortage of specialists, 22 and improved heart failure management. 23 Studies have been conducted on the patient population, locations, and clinical skills covered during GM training.…”

Will the Introduction of the Hospitalist System Save Japan?

“…On the practical side, Hamada et al showed that hospitalists improve the care of patients with urinary tract infection ( 6 ). Other research from Japanese groups also demonstrated that the length of hospital stay was significantly shortened after the introduction of a hospital medicine department (adjusted difference -0.659 days; 95% confidence interval -1.118 to -0.136; p=0.01) ( 7 ).…”